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Community pharmacists should do more to help people with diabetic foot problems avoid amputation, experts are saying.

Over a year, researchers from University Hospitals of Leicester identified 20 patients with active foot disease who were ‘delayed new referrals’. In 16 patients, the median time from first symptom to referral was 25 weeks, resulting from their reluctance to attend the clinic or lack of understanding of the significance of their foot disease.

Three patients presented with gangrene and the researchers identified one case of Charcot’s arthropathy. Five patients needed ‘minor’ amputations due to foot sepsis or osteomyelitis. One patient needed an above-knee amputation for a non-revascularisable limb that presented with toe gangrene and rest pain.

“Diabetic foot problems can deteriorate very quickly. As a result, they require rapid treatment and assessment,” says Nikki Joule, Diabetes UK policy manager.

“Community pharmacists can contribute directly to the prevention of foot problems by encouraging people with diabetes to get their annual foot checks, and making sure they are aware of their risk of developing foot problems and what they need to look out for.”

“Community pharmacists should signpost patients with possible diabetes-related foot problems to appropriate services,” adds Dr Kath Higgins, diabetes consultant at University Hospitals of Leicester and one of the study authors.

“They should be aware of the referral pathways in the Diabetes UK ‘Putting Feet First’ literature and their local pathways to ensure that they are signposting appropriately. Pharmacists should also understand which foot problems require urgent attention. It is vital that patients with diabetes and foot problems obtain specialist advice at the earliest opportunity.