Diabetic Foot Ulcer
Anyone with a diabetic foot ulcer must be quickly referred to a specialist team of medical practitioners. With immediate action, it is possible to prevent the wound from deteriorating and preventing any further tissue death. But if treatment is delayed, the patient may end up losing their foot.
If you have undergone a foot amputation because a diabetic ulcer was not diagnosed and treated appropriately, you could be the victim of medical negligence. This will entitle you to pursue a claim for compensation. Contact us to find out more.
What is a diabetic foot ulcer?
When a patch of skin on the foot breaks down and exposes the tissue underneath, the individual may be suffering from a blister, cut or scratch. Normally this will heal within a couple of days, but if it is very slow to heal then a foot ulcer has developed. Foot ulcers are more common in people with diabetes.
Why are diabetics prone to foot ulcers?
Diabetics are more at risk of foot ulcers because of certain diabetes-related complications. Most frequently, a diabetic patient who develops a foot ulcer will have one or both of the following:
1. Peripheral neuropathy
Diabetes is when the body cannot absorb glucose (sugar) properly, causing it to remain in the bloodstream. Diabetes can be managed by injecting or ingesting the hormone insulin, which enables the body to absorb glucose instead of it remaining in the bloodstream.
However, it can be hard to maintain an even blood sugar level, and this can lead to damage. Just having a slightly higher than normal blood sugar level will soon harm the nerves, particularly in the extremities – i.e. the hands and feet. This is called peripheral neuropathy.
Because nerves allow us to feel sensation on our skin, peripheral neuropathy can cause numbness in the feet. Consequently if someone with peripheral neuropathy develops a blister or cuts their foot, it may take some time before he/she actually realises.
In the meantime, the open wound will be left untreated and will be exposed to infection. The person may also continue walking around, with their shoes rubbing against the injury and causing further tissue deterioration. All this can cause the injury to become worse and develop into an ulcer.
2. Peripheral arterial disease
Having high blood sugar levels can also cause fatty deposits – called atheroma – to build up in the arteries of the legs. People with diabetes also often have high blood pressure, weight issues and poor activity, all of which can contribute towards atheroma.
The fatty deposits will reduce the flow of blood through the leg arteries, leaving the feet deficient in blood and oxygen (which is carried around the body in the blood). Skin that does not have a good blood supply cannot heal very well. So if the skin on the foot is injured, the tissue will not mend easily and an ulcer can develop.
Referring a patient with a diabetic foot ulcer
People with diabetes are encouraged to check their feet regularly and seek medical advice if a cut or sore does not heal. Diabetic patients should also be invited to attend an annual foot check with a diabetic foot specialist.
If a diabetic patient does present with a foot wound that is failing to heal, he/she must be referred to a specialist in diabetic foot care. Those in the early stages can attend an appointment the following day. But if the patient has progressed to the advanced stages, an immediate referral is required.
The signs that mandate an immediate referral are:
- Ulceration with fever or signs of sepsis
- Ulceration with lack of blood in the foot
- Deep-seated infection
- Gangrene
As long as the patient is referred in time, the foot ulcer can be successfully treated. But if there is a delay, the ulcer can become infected and the surrounding tissue will die. The size of the ulcer will then grow, potentially going down to the bone and/or to an extensive amount of tissue. At this point the ulcer will be very hard to treat.
Treating and monitoring a diabetic foot ulcer
According to the National Institute of Health and Clinical Excellence (NICE), the following treatments are required:
- Control of foot infection
- Control of ischaemia (lack of blood and oxygen)
- Wound debridement
- Wound dressings
- Offloading – taking weight off the foot
For those whose ulcer have not yet become severe, treatment typically includes washing the ulcer and dressing it. Antibiotics can be given to ward off infection, and if any pus is present this will need to be drained off. The patient may also be advised to wear special insole/shoes to prevent any rubbing against the ulcer.
The size, depth and position of the ulcer should also be recorded. There are different ways of recording an ulcer, including the University of Texas classification system and the SINBAD system. NICE does not recommend using the Wagner scoring system.
The foot ulcer should then be closely monitored to check that it is healing properly. If the degree of healing is minimal, further medical interventions may be required.
Treating a severe diabetic foot ulcer
As mentioned earlier in this article, the longer a diabetic foot ulcer is left, the harder it is to treat. The ulcer will grow in size, causing more and more tissue death. It can also become infected, which can then spread to the bone and even to the bloodstream. This can make a patient critically unwell and will necessitate extensive debridement surgery (where the dead tissue is surgically cut away). If the tissue death is widespread it may not be possible to save the foot and an amputation will be the only option.
Failing to refer a diabetic patient with a foot ulcer
If an amputation is needed because of a delay in care, it should be considered whether or not medical negligence is to blame. Medical practitioners have a duty to refer a diabetic patient with a foot ulcer within the recommended timeframe. Depending on the severity of the ulcer, this referral should be achieved immediately or within a day. Diabetic foot specialists should then provide the necessary treatment and monitor the healing of the ulcer.
A failure to achieve this standard of care may amount to a breach of duty. If the patient suffers adverse consequences – such as a foot amputation or sepsis – there could be grounds for a medical negligence claim. Contact us at Glynns Solicitors to find out more.
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