In 2016, I joined Compleet Feet, having previously worked 11 years for the NHS Podiatry Service Provision. In my previous NHS role I primarily treated patients with ‘high risk’ foot complications often associated with diabetes. The main objective was preventive podiatry foot care to negate the need for amputations. Having an amputation has a huge impact on people’s lives e.g. mobility, independence etc. not to mention the financial impact on the NHS. It is estimated for every £150 allocated to the NHS services, £1 of that is spent on diabetic patients.
My role as a podiatrist within the NHS was to receive high risk category patients before amputation became the only resort. It is vital to catch these patients ideally at the ‘at risk foot stage’ or early on if they acquire a foot wound.
Integrated Referral Care Pathways are devised to link up Primary and Secondary care services to work together to achieve optimal outcomes. This would start initially with the patient informing their GP or nurse immediately upon detection of foot ulceration so they could be referred on to the podiatry service. On receiving the referral, the podiatry service would within 48 hours offer the patient an appointment either with myself or a colleague in a similar role. Time is of the essence. Once the patient was in clinic I would undertake a thorough consultation. This would include patient’s medical history, examine their feet to identify the risk factors that lead to the ulceration, review their footwear and discuss with the patient what events led up to them developing an ulcer.
Allocated appointment times never seemed enough sometimes as so much detailed information needed to be collected. Once I had collated all the relevant information I would need to examine the ulcer looking at the size, location of the wound, depth – what tissues are visible at the base of the wound and general tissue viability. Often wounds can extend as deep as bone! Is infection suspected? If I suspected bone involvement, osteomyelitis I would need to collect small bone or soft tissue fragments for pathology examination. I would also take wound swabs. These would be sent to the hospital microbiology lab to identify causing organisms of infection so an antibiotic regime can be tailored to that patient.
Actual treatment of a diabetic ulcer would require debriding, removing any of the necrotic tissue present to allow wound healing. This is done with a scalpel. I would then select a dressing from a wide range, best suited for the patient. As a podiatrist, I am skilled in wound care and being able to off-load areas of pressure to allow wound healing with deflective padding. Patients may be given specialist orthopaedic shoes, or require total contact casts.
Long term care plans for these diabetic patients is just as important as short term. Part on my role in treating ‘at risk’ patients was to triage and act as a key referrer to direct people on to a vascular consultant. This would be if it was determined the foot or leg required re-vascularisation. They may require a surgical procedure to improve the circulation, or sadly a surgical amputation! I am pleased to report that Portsmouth NHS is successfully reducing diabetic amputation rates by an impressive 25%.
Those that did not require seeing a consultant may just require a referral to the orthotist for bespoke surgical footwear to help prevent re-ulceration. I always used to stipulate as I do with any diabetic patient the importance of keeping blood sugars within healthy parameters, eat healthily and regular exercise. The importance of good fitting footwear, looking after the condition of the skin and checking their feet daily for any potential problems. These life style measures go a long way in reducing risk factors.
Portsmouth NHS Encouraging Statistics
August 2011 – 53 major amputations in preceding 3 years
January 2012 – 48 major amputations in preceding 3 years
January 2013 – 36 major amputations in preceding 3 years
