In the setting of diabetes, changes occur to the structure, blood supply and health of the feet. This is caused by many factors, including neuropathy (damage to the nerves), abnormal foot mechanics, and disease in the leg arteries supplying the feet.

These changes result in patients with diabetes being at high-risk of developing foot ulcers (wounds). Overall, 25% of patients with diabetes will develop a foot ulcer during their lifetime. This is a serious problem, as 50% of these ulcers become infected.

Diabetic Foot Ulcer
Figure 1: A Diabetic Foot Ulcer

Established infection in patients with diabetes can be a risk to life and limb, and can be non-responsive to antibiotic therapy alone. In order to control severe infection, amputation of one or more toes, the forefoot, or even the leg may be required.

The key to avoiding an amputation is careful care of the feet and prevention, or early treatment, of ulcers.



If you develop an ulcer on the foot, Mr Milne will thoroughly assess foot and its blood supply. A duplex ultrasound of the leg arteries may be performed, as well as measurement of the blood pressure in the toes.



Conservative management with pressure care to the ulcer +/- antibiotics is sometimes all that is needed. If the blood supply to the foot is poor, Mr Milne may suggest a procedure to improve perfusion, usually via minimally-invasive endovascular treatment (angioplasty +/- stent). If there is infected or gangrenous (non-viable) tissue, this may require a procedure to remove the unwanted tissue from the foot and allow it to heal.

Mr Milne works closely with a team of endocrinologists (specialists in the management of diabetes), podiatrists and orthotists. After initial treatment, he will ensure ongoing review with the team to ensure that your diabetes is well-managed and that your feet are carefully monitored.