Page last updated at 23:37 GMT, Saturday, 17 October 2009 00:37 UK

'Aggressive care saved my foot'

By Jane Elliott
Health reporter, BBC News

John Parker
John Parker's foot was saved

This article contains a graphic image of an infected limb.

Pensioner John Parker, from Bromley, Kent, walks with a stick to help him balance.

But despite this John, who has type 2 diabetes, knows he is a lucky man.

For he has had months of diabetic ulcers and could have lost a few toes, or even his foot.

Thankfully, through aggressive treatment, doctors were able to save all John's toes.

But recent figures show that many are not as lucky.

The NHS spends £600m a year on treating foot problems in people with diabetes, and £252m of this is spent on amputation.

Diabetes can cause damage both to the nerves of the foot, and to the blood supply that keeps the foot tissues healthy.

I think I must have very good healing properties - my mother lived to 104
John Parker

Both can lead to foot ulcers and slow-healing wounds which, if they become infected, can result in amputation.

Professor Mike Edmonds, a diabetic consultant at King's College Hospital, London, treated John.

He said there are about 100 amputations a week in the UK because of foot ulcers.

But he believes at least half of these could have been prevented.

The key, he says, is to ensure patients get speedy, aggressive treatment, provided by experts across a range of disciplines.

It is an approach that Professor Edmonds has pioneered at his clinic, which takes on patients with the most severe of symptoms.

It has the facilities to offer interventions such as radiology to improve circulation in the legs, and bypass surgery to clear blockages in damaged blood vessels.

"Our remit is to get patients out of trouble quickly," said Professor Edmonds.

"It is all about preventing the natural disease progressing to an irretrievable state.

"It is about putting all these measures into use to preserve the limb."

Saving limbs

The clinic sees around 20-35 cases each day in the foot clinic, but only have about two to three amputations each year.

It compares very favourably with other units - particularly as some patients have been referred for a second, or even third, opinion.

John - who has had heart and renal problems - was admitted to the clinic as an emergency.

He realised he could lose some toes - but was not aware until after his treatment that his whole foot was at risk.

He underwent bypass surgery to clear the blockage in his leg and angioplasty to widen his femoral artery.

Diabetic foot. Pic caption: Eamonn McNulty/Science Photo Library
Diabetics can cause severe damage to foot tissues

"Possibly he would not have been considered for surgery in other places because of his heart problems," said Professor Edmonds.

"But here he had a package of multi-disciplinary care that saved his leg."

John's wife Sheila agreed that her husband had been a lucky man.

"They were a bit hesitant because of his heart trouble," she said.

"They very carefully explained all the pros and cons.

"They told us afterwards that he could have lost his foot - but it didn't sink in at the time."

John agrees that the hospital was vital in his recovery, but also credits his own genes for helping.

"The bypass has healed perfectly," he said.

"I think I must have very good healing properties - my mother lived to 104."



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