Diabetes and Feet: Everything you need to know ! JACLYN GLAZEBROOK ADVANCED PODIATRIST: DIABETES

1. Diabetes and Feet:Everything you need to know! JACLYN GLAZEBROOK ADVANCED PODIATRIST: DIABETES Nottingham University Hospitals – Dundee House, City Hospital Jaclyn.Glazebrook@nottshc.nhs.uk

2. What do you need to know? Why all the fuss?: Facts and Figures How does diabetes affect the feet? Neuropathy Peripheral Arterial Disease Other Risk Factors What do we do when we find a problem? = Podiatry & MDFT Referral

3. So…what’s all the fuss about the diabetic foot? Facts & Figures…

4. The Human Cost…

5. The Human Cost… >1 in 10 of these people will go on to have an amputation of some form England 2016: More than 135 amputations a week in people with diabetes 1 in 6 (17%) die within a year, 78% in 5 years Only 50% of people who have had amputation survive for 2 years 80% of amputations are PREVENTABLE

6. The Financial Cost… Diabetes Foot Ulcers and Amputations in NHS England (2012) £639-662 million in 2010-11 £1 in every £150 spent in NHS Equates to 0.7% of total NHS budget £306-323 million: primary/outpatient care £256-263 million: inpatient care/A&E £76 million: post amputation care

7. But what does that mean to me? Nottingham: 2012 - 2015

8. But what does that mean to me? Nottingham: 2012 - 2015

9. Diabetes Foot Problems = And in clinical terms… Most common reason for hospital admission for people with diabetes Longest episodes of inpatient care for people with diabetes Increase in Multi Drug Resistant Organisms Increase in Hospital Acquired Infections Major Long-Term Impact on Quality of Life

10. Risk Factors for Developing Diabetic Foot Complications: Peripheral NeuropathyPeripheral Arterial DiseaseSignificant structural deformitySkin changes/significant callus Previous ulceration/amputationInability to self carePoorly fitting footwearChronic Kidney Disease So…how does diabetes affect the feet…In real terms

11. Damage to the peripheral nervous system High blood glucose damages small blood vessels that feed the nerves A sufficient supply of nutrients and oxygen no longer reaches the nerve, causing the nerve to become damaged and eventually die Peripheral Neuropathy… Affects between 20-40% of people with diabetes

12. Peripheral Neuropathy affects… Sensory Nerves – Transmit pain, temperature & touch Many Many people who have sensory neuropathy often have no symptoms and are often unaware of it’s presence damage causes: Reduced sensation Pins and needles Reduced awareness of pain Burning Reduced awareness of hot and cold Numbness = Loss of Protective Sensation (sensory neuropathy)

13. Loss of Protective Sensation?

14. Able to pass sterile probe through connecting ulcers without feeling it! Ouch??? What else can’t they feel???

15. Peripheral Neuropathy affects… Motor Nerves • Carry impulses from the brain & spinal cord to muscles enabling movement damage causes: Weakness of the small muscles that maintain normal foot shape = change to foot shape Loss of muscle strength which affects muscle movement = Altered Foot Shape = High pressure = Callus =Tissue Stress = Increased Mechanical Load & Shear = Reduced Shock Absorption

16. Peripheral Neuropathy affects… Autonomic Nerves - Regulate sweating and perfusion to the limbs damage causes: Reduced sweating Dry inelastic skin Inhibited thermoregulatory function =development of splits, cracks and fissures = portal of entry for bacteria ESSENTIAL to provide good quality emollients and advise on daily use FOREVER