Data released this week shows that amputation rates in people with diabetes have perhaps not surprisingly risen yet again.

In the three years from 2015 -2018 7,545 major amputations were undertaken, compared with 6,957 between 2012 – 2015, an increase of 8%.

But what do those numbers actually mean? For me it means we’ve failed yet more people. Foot ulceration should be the most preventable complication of diabetes.

If people with diabetes had the tools, support and resources to understand why they should check their feet, how to care for their feet in order to prevent problems, what to look for in terms of possible foot troubles and what they should do and who to contact if they were worried about a potential complication, many foot ulcers could be prevented from developing.

But what do these “tools” look like? Education can mean different things to different people, giving a leaflet and assuming people will act on that information is not enough, “telling” people what to do does not lead to them acting on that advice.

Often as health care professionals (HCPs) we want people to act as we have been taught from a text book. However supporting effective self-care is complex: self-care decisions and behaviours are entwined in personal and family experiences of illness, responses to illness and an individual’s underlying guiding values and aspirations. Perhaps one of the key issues in foot care management is that HCPs who are involved in foot screening and the delivery of preventative foot care education do not have sufficient training and expertise to support people to adopt foot self-care regimens.

Often people with a foot ulcer are often considered to be ‘non-compliant’ by HCPs. However such labels and negative value judgements can create further barriers between the person with diabetes (PWD) and the HCP. It is therefore important that HCPs reconcile the clinical view of a situation with the person’s experience of illness to achieve a truly person-centred relationship.

A recent article by Renza Scibilia discussed eloquently how damaging terms such as non-compliant and non-adherent can be.

So how do we move forward?

We as health care professionals have to recognise that complications do not mean that person has failed. Often that person will have done the best that they could. The language we use can have a profound impact on how people respond to our advice and guidance as highlighted by the language matters publication.

Last month I attended the annual Diabetes UK professional conference, where they had a workshop session on caring for people with foot related issues.

Chris Aldred aka the Grumpy Pumper spoke passionately about his own experiences of living with a foot ulcer, from thinking he “only had a blister” to realising the break in the skin on his foot was rapidly becoming a significant problem that would result in him living with a foot ulcer for almost a year.

During this time he described how vital it is that we treat the whole person and not just the body part. I’ve written previously about how we need to stop referring to the “diabetic foot” it is the person that lives with diabetes and it affects all aspects of their lives.

During Chris’s superb account of his experiences he stressed the need for HCPs to use language that is supportive and understanding rather than being critical or judgemental. He described how if during a consultation his internal voice hears language or words that don’t actively support him then he will disengage from that conversation.

He used the analogy of how when he feels isolated or demotivated because of his clinical encounters, it can be likened to travelling down the treatment pathway with flat tyres – and that everything then becomes so much harder to keep moving forward.

If we are to improve things for PWD we need to meet them at the gate, be welcoming and help them set meaningful goals to develop the best outcomes, but this needs to be done together. Living with a foot ulcer is incredibly challenging, pathways in the UK are not clear and it is often difficult to access the right care at the right time.

It becomes even more difficult peddling through that treatment pathway when the air in your tyres is going down.

The professional-patient relationship can quickly become demoralised if a person’s question goes unanswered, or if there is an unwillingness to respond to a question, or if the professional response contains value judgements or attributions of blame – thereby setting the individual’s future expectations still lower.

Interpersonal rapport, the exchange of information, empathy, and trust – are accomplished or undone, based upon the resources that the person brings to the health care encounter and the HCPs response.

Effective foot care management and self-care support should therefore be developed in a format that allows both patients and HCPs to collaborate in the development of self-management plans that integrate the clinical expertise of HCPs with the concerns, priorities and resources of the person with diabetes.

A truly collaborative approach between healthcare professionals and people with diabetes is required if foot health outcomes and preventative foot care practices are to be improved.




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