Primary care teams urged to watch for diabetic foot ulcers - Diabetic Foot Ulcers for Health Providers

Primary care teams urged to watch for diabetic foot ulcers
July 1, 2008
Sara Freeman
BNET

GLASGOW, SCOTLAND -- Diabetic foot ulcers requiring urgent specialist care can be covered up by calloused skin or not recognized soon enough as being Charcot's foot, and a consultant podiatrist has urged all those working in primary care to be on high alert.

"Somewhere in the world, every 30 seconds, a limb is lost to amputation," said Louise Stuart of the Manchester (England) Primary Care Trust. "It's the most common reason why patients get admitted to hospital with diabetes," and patients with diabetes account for 70% of all amputations, she added.

"But the biggest light at the end of the tunnel for these patients is that integrated care, focusing on patients at a very early stage, does work and up to 85% of amputations are avoidable," Ms. Stuart said.

She urged attendees at the annual professional conference of Diabetes U.K. to be aware of the problem and to refer patients for appropriate treatment in time.

Screening for foot ulcers should be as routine as measuring the blood pressure of patients with diabetes, but it is often the last thing that gets assessed, she continued.

This is the one area of diabetes management that can get health care professionals into trouble, with patients filing lawsuits for negligence.

That's because a seemingly "low risk" diabetic foot ulcer can transform overnight in some cases, and may result in an amputation that could have been avoided if treatment had been given sooner.

Both feet should be checked routinely, even if the patient already has an ulcer on one foot and is reluctant to remove the other shoe.

Often the other foot may be at risk because the patient is wearing damaged or worn-out footwear.

Ms. Stuart further advised that if a patient with diabetes has flulike symptoms and hyperglycemia, the feet should be checked for possible ulceration.

A specialist referral should be made if there is any suspicion of a diabetic foot ulcer. If the patient appears to have hardened yet painless calluses on the feet, this is a warning sign and could indicate neuropathy and underlying ulceration, she said.

If there is an area of callus, the patient has a high-risk foot, Ms. Stuart said, adding that "if that area of callus has any appearance of extravasation in the base of it, consider it already ulcerated."

Dry, cracked skin is also a sign to watch for; it is not a cosmetic problem. Broken skin can be a haven for infection.

A simple means of screening for diabetic foot complications is to lift the leg. If pallor in the foot is present on elevation of the limb, this could indicate a poor arterial supply.

"Remember, a warm, swollen foot with no evidence of infection is 'Charcot' until proven otherwise. That patient should not be walking out of your [office]," Ms. Stuart said.

A 'low risk' diabetic foot ulcer can transform overnight, resulting in an amputation that could have been avoided with earlier treatment.