NewsDiabetics giving amputations the boot

Diabetics giving amputations the boot

Diabetic foot ulcers, Wellbeing and concordance

Diabetics giving amputations the bootDiabetics once facing the prospect of amputation to their lower limbs due to the effects of foot ulcers are now back on their feet thanks to a new technology.

Foot ulcers are common for diabetics as they often suffer from reduced sensation on the skin. Even a slightly high blood sugar level can, over time, damage some nerves - a diabetes-related issue called peripheral neuropathy.

If sensation is lost in parts of the foot, it can be difficult to know if the foot has suffered any damage. This also means it is difficult to protect small wounds by not walking on them - and the wounds can rapidly deteriorate and develop into ulcers. Foot ulcers are prone to infection and can quickly become severe and in some cases lead to amputation.

This was the case for William Hutchinson, 57, from Havant, a Type Two diabetic who has suffered from recurrent foot ulcers on both feet for a number of years and was on the verge of having to have a toe on his left foot amputated.

Mr Hutchinson said: "I have very little feeling in my feet, so any cut or nick I get on my feet can quickly turn in to an ulcer.

"I attended clinics for months due to an ulcer which I had on my big toe. I was wearing an air cast walker to try and heal the ulcer, which I'd had for 13 months in total - but this caused an ulcer to develop on my other foot because I was unbalanced. I had the second ulcer for four months."

When Mr Hutchinson was referred to Solent NHS Trust's specialist Podiatry Team at St James Hospital in Portsmouth, they suggested a very new approach - and the results were quickly evident.

Mr Hutchinson continued: "My podiatrist suggested I try a new type of total contact cast - and that I try it on both feet. I believe I was the first person in the UK to have been treated with the cast on both feet - and it worked brilliantly. I was absolutely amazed. After 12 weeks, I've virtually healed."

The technology is called the TCC-EZ - and is a Total Contact Casting system. Total Contact Casting is considered the gold standard of care for off-loading diabetic foot ulcers.

The TCC-EZ, from Dermasciences Europe, is a one-piece, roll-on, woven cast that can be applied in just ten minutes by the podiatrist. It works by promoting healing of the wound by minimising pressure and friction, as the TCC-EZ redistributes the weight away from the wounds, meaning it can heal even while the patient is walking. 

Mr Hutchinson attended a specialist podiatry clinic at St James' Hospital, part of Solent NHS Trust. Portsmouth Clinical Commissioning Group (CCG), which works with Solent NHS Trust as a partner organisation, has one of the highest amputation rates in the country at 4.3 per 1,000 adults with diabetes - with the neighbouring Fareham and Gosport CCG highest at 5.1 per 1,000, compared to the national average of 2.6 per 1,000.

The podiatry clinic, led by Podiatrist Advanced Practitioner Emily Sambrook, was trialling the new technology and asked Mr Hutchings if he would like to take part - and the results were dramatic.

Emily Sambrook, Podiatrist Advanced Practitioner at Solent NHS Trust, said: "As a clinician, I'm always a little sceptical about new technologies - but the TCC-EZ is the best new technology I've experienced. Patients who have been seen for many months with little improvement are now healing, in some cases, within eight weeks, which is absolutely fantastic.

"The TCC-EZ is an easy one-stop system and means I don't have to refer patients to have a plaster cast technician, at which point I might lose the patient in the system. This means I can progress a programme of care which allows the patient to follow the right routine and heal more quickly.

"The system also significantly reduces the chance of amputation. We can use the TCC-EZ to dramatically increase the healing process of foot ulcers by reducing plantar pressures - which typically takes many months - and results in less risk of infection. Less risk of infection ultimately means less risk of amputation.

"Our patients often suffer from depression as they can't do what they normally do and can't see an end-goal. They will often ask how long the healing process will take. Using a traditional method, it's very difficult to allocate a timeframe - but now I can provide an end-point based on evidence. The patients we've been dealing with have been amazed how quickly they are healing - and that has had a dramatic effect on their quality of life."

In just 12 weeks Mr Hutchinson went from having ulcers on both feet, with one wound at a depth of 10mm - to almost fully healed and will soon be back on his feet and out walking his dog.

Mr Hutchings continued: "I'm looking forward to getting out walking again - which is my big love. I'm pretty close to getting to that point now, which is just amazing.

"I've now got the correct footwear, which has been specially made, so I can get back to being outdoors and, fingers crossed, everything should be ok now."

For more information on the TCC-EZ click here