Around 6,000 people with diabetes undergo leg, foot or toe amputation each year in England. Major amputation rates in people with diabetes vary ten-fold across primary care trusts 1. Diabetic foot ulcers are a pre-condition for amputation and preventing and managing them will significantly reduce harm.
The outcome of management of diabetic foot ulcers is poor, and there is continuing uncertainty concerning optimal approaches to management 2. Good foot care is essential in preventing the development of diabetic foot ulcers.
A literature review on managing diabetic foot ulcers including 43 papers and updating a previous review from 2006 was published in 2012. A systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes concludes that apart from the use of hyperbaric oxygen therapy there is little evidence for newer treatment options.
Minimum skills framework
The National Minimum Skills Framework for Commissioning of Foot Care Services for People with Diabetes outlines the minimum skills required in the UK to ensure good quality foot care. It provides a supportive quality assurance mechanism for commissioners and service leads to ensure that appropriately skilled health care professionals provide care.
Current guidance and provision of care
An analysis of both the current provision and quality of care for diabetic foot problems and of the evidence for improving care, the NHS Diabetes paper Foot Care for People with Diabetes: The Economic Case for Change, acts as a basis for identifying potential quality and productivity improvements. It analyses which improvements in foot care are cost-effective as well as clinically effective.
NICE have published guidance on the evidence base for the best management of diabetic foot problems. Improving patient safety around foot problems requires implementation of the guidance into practice and this podcast from NICE by Mark Collier, a lead nurse consultant for tissue viability, discusses how it can best be introduced into practice.
Game FL et al. A systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev. 2012;28(Suppl 1):119–141
Foot Care for People with Diabetes: The Economic Case for Change. NHS Diabetes, 2012.