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Fast treatment helps to reduce serious foot disease in patients with diabetes

 Sheffield Hospitals podiatry team are amongst the best in the NHS for helping diabetic patients prevent foot ulcers which left untreated can lead to foot amputation.

Latest figures show that 85.7% of patients with diabetic foot ulcers were seen within 13 days of presentation at Sheffield Teaching Hospitals NHS Foundation Trust, compared to an average of 66.6% in England and Wales as whole. The Trust is the best performing major centre in the country by this measure.

Seeing patients quickly is vitally important because ulcers can deteriorate rapidly and are very prone to infection. A less severe ulcer can become a severe ulcer within a matter of weeks and ultimately lead to amputation if not treated.

At Sheffield Teaching Hospitals, changes which were made to how the diabetic foot team worked during the pandemic have helped to see more patients more quickly despite rising demand. These changes are now embedded in the service.

Foot clinic sessions in hospital now focus on seeing the most serious cases, while less severe cases are seen in a patients’ home thanks to investment in additional community podiatry capacity.

Patients are referred to the community podiatry team, which includes specialists in vascular assessment, renal and lower limb wound care, the same or next working day. An image sharing platform has also been set-up to enable the podiatrist to share images of the foot if immediate consultant advice is required.

Jeremy Walker, Head of Podiatry Services, said: “Between 2008 and 2024, incidences of diabetic foot disease in Sheffield has almost tripled, rising from about 4,500 to 15,000 cases a year, which follows a national trend of rising numbers. We think it is to do with people living longer with diabetes due to better disease control. It is now more common to see people living into their 80s and 90s.

“People with diabetes are prone to foot problems because the disease leads to a loss of sensation and protective pain along with a reduced immune response and poor circulation. For example people may walk for miles in badly fitting shoes, being completely unaware of injuries or pressure points. This can lead to deterioration in the condition of the feet, and poor nutrition and circulation can then mean poor healing and rapid deterioration. Sometimes this is exacerbated by other conditions such as heart and kidney disease.

“Ultimately a lack of treatment can lead to infection and amputation, which has not only physical but psychological consequences. Having an ulcer can also be quite socially isolating if it prevents you from your usual activities.

“Time is tissue when it comes to treating diabetic foot ulcers, and it is very important that patients check their feet every day and have an annual foot check with a health professional to prevent the worst deteriorations.”

Paul Hirst, 67, of Stocksbridge, has had diabetes for about 15 years and his condition meant that he could only walk about 20 metres and used a mobility scooter. He also smoked about 50 cigarettes a day.

He was at significant risk of foot ulceration and told the diabetic foot care team that his motivation was to be able to walk far enough to take his grandchildren to the park again.

Working with the podiatry team, he gave up smoking with the help of e-cigarettes, improved his diet and began using a foot cycle every day for exercise. Within the space of a year he had progressed to the point that he could walk as far as he wanted pain free and his ulceration risk had reduced from 44% to 11%.

His wife has also given up smoking after seeing the difference.

Paul said: “Before I would get really bad cramps in my feet or a feeling of numbness, but I don’t get that now, in fact I have never had them since making these changes.

“I have nine grandchildren and I would not have taken them out before. I wouldn’t have gone to the park. Being able to do that was a big thing for me. Now I can go and watch them play football.

“I don’t use my mobility scooter any more, I can go to the shops without it. We got a new car and drove up to Scotland and went on walks.

“It didn’t happen overnight, I have put a lot of effort into it. I would get out of bed and the first thing I would do is use the foot cycle. To walk three times around our apartments is a mile. At first I could only get a quarter of the way round but now I can do it all no problem. I’ve put a lot in and got a lot out. I’m saving £40 a week on cigarettes too.

“Without the diabetic foot team I don’t know where I would be, I don’t think I would be here without them.”