Lower limb amputations of diabetic patients are the leading cause of limb loss in the UK and many overseas countries other than limb amputations caused by accidents. It is estimated that around 3,000 lower limb amputations are carried out each year in the UK alone and this is a major burden on the NHS. Ongoing rehabilitation costs and payment of disabled allowances is a further burden on the NHS and Social Services as very few diabetic patients who have undergone lower limb amputations are able to continue in employment.

There are an estimated 500,000 insulin dependent diabetic patients in the UK along with probably 2 million non-insulin dependent diabetic patients and probably another 1 million undiagnosed potential patients. Many of these patients could be vulnerable to encountering diabetic foot problems in the future.

Diabetes can affect the nerves in the feet by distorting the messages which go from the foot to the brain causing numbness, loss of pain sensation and temperature perception, burning shooting pains and pins and needles. This nerve damage is neuropathy.

Diabetes can also affect the blood supply to the feet and legs causing sores or cuts to be slow to heal. Minor cuts or sores can be easily infected if not properly treated and lead to serious long term foot problems.

Many patients with diabetes develop ischaemic or neuropathic ulcers leading to haemorrhagic changes.

From a clinician’s point of view diabetic foot syndrome is defined as legions in connection with diabetes. The condition is characterized by multiple aetiology.

  • Ischaemic or neuropathic ulcers leading to haemorrhagic changes
  • Mechanical factors
  • Metabolic stimulation of growth factors with an increase in glycosylated end products
  • Increased permeability of the vessels

The prognosis for diabetic foot syndrome is very poor without therapy however neuropathy in many diabetic patients often advances out of control and leads quickly to acute diabetic foot syndrome often requiring lower limb amputation.

What is Diabetic Neuropathy?

From early diagnosis of diabetes, most people are told to look after their feet because of the risks that long-term diabetes or poorly controlled diabetes can cause nerve damage. This is just one form of diabetic neuropathy but probably the most common and well known form.

Neuropathy means damage to the nerves supplying any part of the body but is usually divided into two categories peripheral neuropathy or autonomic neuropathy.

  • Peripheral neuropathy affects the nerves supplying the skin and muscles.
  • Autonomic neuropathy affects the nerves supplying the organs such as the bladder, bowel or heart. It can damage the nerves responsible for controlling blood pressure, sexual function etc.

Neuropathies fall into two broad categories:

  • Diffuse neuropathy affecting many nerves either the sensory or the autonomic nerves. This is the most common form and is the one that can affect the feet.
  • Focal neuropathy affecting individual nerves – for example, this is the type that can cause impotence.

Neuropathy affecting the feet

Care of the feet is very important for people with diabetes because of the risk of diabetic peripheral neuropathy. Systematic and regular foot care has been shown to reduce ulceration and limb loss by up to 50% and almost half of all diabetes related admissions to hospital are for problems related to the leg and foot.

Prevention is always better than cure and so obviously it is important to have regular checks of your feet by health professionals and to regularly examine your feet yourself.

The Golden Rules for Looking After Your Feet

  • Never go barefoot.
  • Wear good fitting shoes – not tight or worn.
  • Break in shoes gradually and make sure they don’t rub.
  • Keep your feet dry, especially between the toes.
  • If you need to use powder, use the unscented varieties.
  • Use lotion to keep the skin soft so that your feet do not get dry or cracked.
  • Cut your toenails straight across, not deep into the corners.
  • Wash your feet daily using luke warm water.
  • Do not use heating pads, hot water bottles, iodine, Epsom salts or alcohol.
  • Check your feet every day and if there are any problems see your doctor or chiropodist.