Foot Ulcer Recommendations August 2023 -Parte 1-

18 Ottobre 2023 admin

In England, there is considerable variation in foot ulcer management and outcomes, thereby
increasing care costs4 and extending healing times. Foot ulcers are precursors of lower limb
amputations both in people with and without diabetes. While the quality of foot ulceration care has
steadily improved for people with foot ulceration and diabetes, care for those without diabetes lags
behind5
. People with diabetes who develop foot ulceration can access expert multidisciplinary
treatment far more easily than those without diabetes.
Those with foot ulceration, whether associated with diabetes or not, are at high risk of lower limb
amputation and associated with higher mortality rate5
.
Foot ulceration is usually caused by combination of factors including peripheral arterial disease,
peripheral neuropathy, and infection and rapid assessment, diagnosis and treatment is crucial for all
those who develop it.
This is particularly important for individuals who do not have diabetes, since they account for all major
amputations5
, however, they have not had the same historic rapid access to foot services.
The establishment of diabetic foot clinics has done much to address the needs of those with diabetic
foot ulceration, but such clinics have not been historically designed or resourced to meet the needs of
people with foot ulcers without diabetes. The NWCSP recognises that whilst some healthcare
services have adopted a more generic ‘high risk foot’ approach to address this inequality, more needs
to be done to ensure that all people with foot ulcers can access appropriate, timely care.
There is a strong argument that equitable commissioning of accessible services for all foot ulceration
would reduce unwarranted variation of care, increase the implementation of evidence-based care,
and discourage the over-use of therapies for which there is insufficient evidence. It is envisaged that
these changes would result in higher healing rates and lower recurrence rates and therefore offer a
cost-effective option.
Prevention of injuries (which may be the start of lower limb ulceration) is outside the remit of the
NWCSP, but early appropriate care can prevent foot wounds becoming foot ulcers…