A person with diabetes is unable to maintain (regulate) a normal level of sugar in the blood. This is because of imbalance in the secretion of insulin, the main hormone regulating blood sugar levels, either not being produced sufficiently or is not used by the body adequately. In the UK, Diabetes UK estimates that there are nearly 3 million individuals with diabetes, with numbers rising rapidly.
Among the most feared complications of diabetes are nerve damage and circulation change, especially to the feet. Up to 50% of diabetic individuals have nerve damage or neuropathy and nearly a third ultimately develop significant circulation abnormalities or vascular disease. In addition, diabetics are unable to fight infections as robustly as those without. Together, they put patients with diabetes at a higher risk for foot ulcers and infections that, when left untreated, may result in severe foot changes, resulting in amputation. However, as we have shown in the past, most amputations due to diabetes are preventable. They do require a team who are aware of the challenges and competent to deal with them. At any given point, there are over 60,000 individuals with active diabetic foot ulceration in England.
Our team are able to provide input for Diabetic Foot Ulcers
- Diabetic Foot Ulcers, especially in those with advanced vascular disease
- Charcot Foot
- Advice on Total contact Casting
- Neuropathic Pain
- Severe foot deformities that require ‘reconstruction’
The team will conduct a wound assessment to assess and diagnose the cause of the ulcer and direct further investigations as required. The clinic also participates in research studies offering advanced wound dressings. The following wound management services are available in the clinic:
– Education of current foot health status and lower limb complications associated with diabetes
– Advanced wound debridement including soft tissue and bone sampling
– Wound dressing recommendations and application including the use of advanced wound dressings such as topical negative pressure therapy and larvae therapy
– Weight-bearing and non-weight-bearing offloading recommendations and application
– Blood tests
– Toe pressure assessment
– Microbiological control
Casting immobilizes the foot and is used to redistribute the mechanical forces acting on the foot to slow or stop the progression of an injury such as a wound or a fracture, preserve the foot shape and protect the foot from further trauma. Our team will advise on your ability to weight-bear whilst in a cast and may suggest the use of assistive equipment such as crutches or even up shoes to further offload the affected foot or improve balance. The podiatrists are able to offer a variety of custom and prefabricated casting options including:
– Total contact casts
– Window total contact casts
– Bi-valve (removable) casts
– Scotch cast boots
– Patella weight-bearing casts
– Diabetic aircast walkers
– Post-operative footwear
Charcot Osteoarthropathy is a destructive bone and joint disorder, occurring in a foot with poor sensation, which can result in permanent changes to the shape of the foot. Our service manages acute and chronic Charcot Osteoarthropathy by offering:
– Temperature monitoring
– Directing, referring and interpreting diagnostic investigations including x-ray, bone scan or magnetic resonance imaging (MRI)
– Casting therapy
– Liaising with Orthotic Services for custom footwear and innersoles for rehabilitation specific to the presenting injury
The Diabetic Foot Clinic offers combined clinics with the following specialities for presentations requiring coordinated multidisciplinary care. We attempt to ensure all diagnostic investigations are completed or imported from external hospitals prior to being reviewed in these clinics.
The orthopaedic round will review cases presenting with bony pathology such as osteomyelitis, Charcot Osteoarthropathy and feet requiring surgical intervention ranging from bone biopsy to complex reconstructions. The podiatry team will liaise with the orthopaedic team to provide pre and post-operative wound, offloading and antibiotic management to optimise post-operative outcomes. A ‘Foot School’ program is offered every 3 months to educate patients requiring complex reconstructive surgery.
– Monday 9.00am – 12 noon
– Selected Wednesdays 10.30am – 12 noon
The vascular round will review cases presenting with symptoms of critical limb ischaemia, non-healing wounds related to peripheral vascular disease, direct and provide ongoing monitoring of revascularisation procedures, monitor skin grafts and offer minor emergency procedures in clinic.
– Tuesday 12 noon – 3.00pm
– Thursday 10.00am – 3.00pm
The combined plastics round will review cases requiring options for wound coverage including complex grafting and consult on topical wound care products available.
– Selected Mondays 12 noon – 1.00pm
Patients requiring dermatology input are able to be reviewed on an on-call, case by case basis and the podiatry team will direct the referral accordingly on the same day of DFC treatment.
Diabetes Control Clinic
A diabetes control clinic is available on selected dates of each month for existing patients with a HbA1c of >9% or <6.5% and is to be coordinated with their review attendance in the Diabetic Foot Clinic.
Painful Neuropathy Clinic
All images presented here are with patient consent. Copyright with Kings College Hospital, London.