New Diabetic Foot Care Service in west Essex

Patients with diabetes are set to benefit from a new service launched this week by Essex Partnership University NHS Foundation Trust (EPUT) and Princess Alexandra Hospital (PAH) to prevent serious diabetic foot complications.

The new service is made up of Podiatrists, Diabetes Specialists, doctors and nurses and will treat diabetic patients who are at a high risk of developing serious complications with their feet that can lead to amputations.

10% of people with diabetes will have a foot ulcer at some point in their lives and diabetes is the most common cause of non-traumatic amputations according to NICE Guidance (NG19).

There are currently 14,610 people living with diabetes in west Essex who would require help from the community based EPUT Foot Protection Service or the hospital based Diabetic Foot Care Team.

In 2015/16 there were 104 major and minor lower limb/foot amputations in west Essex.

Early detection of problems with the feet of diabetic patients can prevent serious complications and possible amputations.

Patients who are at risk can be referred to the Diabetic Foot Care Team on 01279 698719 (Monday to Friday 08.00 – 16.30).

A message can also be left on the Out-of-Hours phone 01279 692757.

There are steps that patients with diabetes can take to prevent diabetic foot complications. Patients are advised to monitor poor circulation problems in the legs and feet.

Good diabetes control can save your feet.

Diabetes health tips:

The hardening of the arteries can appear early in people with diabetes, especially if blood glucose levels have been poorly controlled. This causes the skin to be inadequately nourished.

Poor circulation can cause:

1. Coldness of the feet and changes to the skin and toenails
2. Pain in the calf muscles when walking - in this case you should see your GP or Practice Nurse.
3. Wounds to heal more slowly or not at all
4. Pains or unexplained sensations in the feet, especially at night.

With time, damage to nerves can progresses and cause painless or numb feet. This can be very seriou, as you may be unaware of injuries such as cuts or sores. Without treatment these may lead to infection or gangrene.

Make this part of your daily routine:

Check the soles of your feet daily. You may need a mirror to help with this, if your eyesight is poor get a friend or relative to help.

What to look for:

1. Damage to the nerves in the legs:
   
   • Areas that are tender
   • Blisters
   • Sores/open wounds/raw areas
   • Discoloured skin
   • Excessive dryness and cracks - these may be observed in the feet before they are felt
   • Any discharge, redness or swelling.
   • Be careful to avoid overheated baths. The temperature must not be too hot - always test with your elbow first.
   • Do not sit too close to heaters or fires.
   • Remove hot water bottles before getting into bed.
   • Electric blankets should be switched off.

Report any of the above signs and any pains, numbness or slow healing to your GP or Podiatrist. With early treatment problems may be prevented.

Good daily foot care can keep feet healthy:

1. Wash feet daily in lukewarm water
2. Do not soak feet - this can lead to very dry skin
3. Dry carefully between toes using a cotton wool bud if necessary
4. Do not use talcum powder between the toes as it can become clogged and cause irritation
5. If the skin is moist and damp between the toes wipe with surgical spirit on alternate days (only if there are no cracks) 
   • If a crack appears between the toes consult your Podiatrist or Practice Nurse
6. If the skin is dry or hard, use a moisturising cream e.g. E45, Epaderm or Diprobase but not between the toes.

Nail cutting

1. Cut toe nails straight across and file the corners.
2. Do not cut down the sides of the nails or cut too short.
3. Never use a sharp instrument to clean under the nail.

Corns and Callosities

1. Never cut your corns or calluses’ yourself. Do not let a well-meaning friend do them for you
2. Never use corn paints or corn plasters - they contain varying strengths of strong acids which can be extremely dangerous.

Holiday Foot Care

1. Don’t forget to use sunblock or high factor sun cream regularly on feet,
2. Use an insect repellent to prevent bites
3. Take a First Aid kit of plasters, sterile dressings, bandages and tape.
4. Cleanse and cover any injuries - however slight. Check them daily and seek help immediately if they get worse or red
5. Wear socks or stockings to prevent blisters
6. If on a beach holiday do not walk barefoot on the sand or in the water. Plastic shoes are ideal
   • Hot sand can burn your feet and sharp rocks or broken glass can cause serious injuries.

Footwear:

1. Always have your feet measured by a qualified shoe fitter
2. Wear well-fitting lace-up shoes or shoes with velcro straps, fastening with soft leather uppers non-slip and flexible soles with a deep toe cap
3. Buy shoes in the afternoon as feet swell during the day
4. If provided, wear hospital shoes
5. Avoid walking barefooted
6. Trainer type shoes are preferable
7. Slippers do not support your feet and should therefore be worn as little as possible - Slippers should NOT be worn all day
8. Socks and stockings must be big enough and where possible not of the stretch variety. Socks should be made of cotton or wool
   • It is no use wearing well-fitting shoes if socks or stockings cramp the toes
9. Always check inside your shoes to ensure there are no foreign bodies, broken linings, or seams to rub your foot

HEALTH ADVICE

1. It is important that you have an annual diabetic foot check.
2. Keep your glucose levels close to normal
3. Have your blood pressure checked regularly as raised blood pressure can decrease the blood supply to your limbs

Smoking narrows the blood vessels and decreases the blood circulation to your limbs. It makes the chance of feet and limb problems greater. So by stopping smoking it will help your feet. A referral to the NHS stop smoking service could help If you have any concerns at all you should speak to your GP or Podiatrist.