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Poor diabetes foot checks "increasing risk of amputation"

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A significant number of people with diabetes are getting inadequate annual foot checks and this could be putting them at increased risk of amputation, according to new research carried out by Diabetes UK.In anonline survey of 6,6961 people with diabetes, almost a third (32 per cent) said they were not informed about their level of risk of foot problems at the annual foot check that everyone with diabetes should have. The same proportion (32 per cent) said they were not given advice about their foot care. Almost one in five people (18 per cent) said they did not have their feet checked for corns, calluses and changes in shape.The survey results paint a bleak picture, with respondents admitting they often leave their foot check without any information as to why the checks are done, what changes to look out for, or day to day foot care advice. Of the 1,476 people who stated that they had been told they were at an increased risk of foot problems, almost two thirds (62 per cent) reported that they had not been referred to a foot protection team or a podiatrist (which is what the National Institute for Health and Care Excellence recommends). One per cent of people said they did not even remove their socks or tights at their check.One respondent commented: “My check was done at a retinopathy clinic but it was just a cursory look at my feet and even though I said I was suffering from numbness nothing was done or written down. I had to follow it up myself and was eventually referred to a hospital foot clinic.” Another said: “It would appear that if you pass the foot touching with a 'stick' test, then all is fine, regardless of the fact that you have pain in the feet and numbness in the toes.”Diabetes UK is concerned that if people are having inadequate foot checks then they – along with the many thousands more who do not have a foot check at all - are being put at higher risk of amputation. Up to 80 per cent of diabetes-related amputations in England each year are preventable, and the charity is warning that inadequate foot checks are part of the reason that so many amputations happen unnecessarily.As part of its Putting Feet First campaign, the charity is calling for Clinical Commissioning Groups (CCGs), which are responsible for health services in their area, to make sure healthcare professionals carrying out the annual foot check are trained to do so and are given the time to carry it out thoroughly. The charity also wants people with diabetes to know what a good foot check looks like so they can make sure they are getting one.Barbara Young, Chief Executive of Diabetes UK, said: “It is of great concern that so many people are being given foot checks that are not up to scratch. Not only does this mean that we are potentially missing the chance to treat foot problems early enough to prevent amputation, but if people are having poor quality foot checks then they might be getting a false sense of security that everything is all right.“The annual foot check is very much a first line of defence against amputation, and clearly it is not working as well as it should. We know that early treatment can make all the difference when it comes to avoiding amputation, so it is vital that we take action to address this. We want the NHS to ensure that everyone who carries out the foot check understands how to do it and has the time to do it properly. The check must also include telling all people with diabetes about their level of risk of foot problems so they are properly informed and supported to take care of their feet properly.“Getting the foot checks right would have a real impact on the high amputation rate in the UK but, crucially, we need to recognise that this is not going to fix the problem on its own. We need a drive to improve the annual foot check to be part of a wider focus on diabetes-related amputation, which needs to look at all the care people with diabetes are getting, from the foot care information they are given all the way through to hospital care for people with foot disease. Until this happens, we will continue to see the unfolding tragedy of thousands of people a year having to endure amputations that could be avoided.”Top tips for people with diabetes to maintain healthy feet:•    Make sure you attend your annual review (age 12+). Your bare feet should be checked by an appropriately trained person.•    Check your feet every day for signs of redness, pain or damage to the feet, swelling or build-up of hard skin. Look out for any changes in the shape of your foot•    Always wear well-fitting shoes that protect and support your feet and wherever possible don’t wear shoes with bare feet•    Be aware of any loss of sensation in your feet. Don’t go barefoot and avoid extremes of temperature if you think you have lost feeling in any part of your feet.For more tips and further information onDiabetes UK’s Putting Feet First campaign, go to www.diabetes.org.uk/putting-feet-first

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