The Cost Of Diabetic Foot Ulceration

For those of you who have followed this series of articles, you may recall a frustrating & upsetting incident some years ago where someone in Warwickshire had died from an ingrowing toenail. This could have been avoided had they received appropriate care, which, unfortunately, they had not! The patient had diabetes which can influence the feet in so many ways. It can affect the skin, nails, soft tissues, bone, sensation, circulation, and the ability to fight infection. As I explain to my patients, basically anything can go wrong with their feet as a result of their diabetes. The vice versa also applies in that foot problems can impact diabetes itself, especially if foot ulcers develop as they all too often can. So let’s look at the costs associated with such ulceration:

Physical costs of diabetes

There are three main types of diabetic foot ulceration (DFU) – ischaemic, neuropathic, and neuroischaemic, the first one of which can be extremely painful, rendering any activity nearly impossible. Even putting footwear on or lying in bed can cause intense pain. The other two types aren’t generally painful as the foot has lost sensory feedback. However, to assist with the healing of these, the ulcers need to be offloaded with padding, insoles or footwear modifications or cast boots (fixed or removable). These can make normal weight-bearing activities difficult, even if the treatment is just restrictive on the type of footwear patients are able to wear. Then there is the possible outcome of amputation because of complications with the ulcer, which could threaten the viability of the foot/leg/life itself. If that is the case, then wheelchair use for the rest of life may be the long-term outcome.

Emotional costs of diabetes

DFU can be distressing. The journey to resolution can seem to be haphazard, with the constant risk of deterioration, and that can challenge even the most resilient of people. If the patient is apparently accepting of the journey, then that can be due to a lack of understanding of the possible consequences or just a blasé attitude to their foot problem. In this case, it is often the patient’s partner/carer who is emotionally invested in the foot ulcer, and this can cause anxiety, frustration, and even anger within the relationship with the patient.

Financial costs of diabetes

DFU can lead to multiple episodes of time off work or necessitate a change in the type of employment that is possible, which can then reduce income for the patient and their family. Whilst good NHS care is freely available for the treatment of DFU, the financial cost of recurrent hospital appointments, parking costs, and non-earning time spent waiting at those appointments can soon mount up. High-quality, effective private care is available from a limited number of Podiatrists (Foot Specialists) who have the skills, experience, & equipment (such as low-level & high-intensity laser therapy) to help resolve DFU. The private option does bring benefits to patients in terms of choice, flexibility, and continuity of care by the same practitioner, but it is important that good links with other members of the multi-disciplinary team are in place for patients to access timely and appropriate care in the event of complications developing such as spreading infection. As each case really is unique, then it is difficult to provide good guidance on private costs but potentially allow £200 to £1000+ to resolve DFU and additional costs to maintain that resolution.

Jonathan Small

Lead Podiatrist (and former NHS Diabetic Foot Specialist)

Health First Foot & Gait Clinic

Here is a 5-star review from one of our longstanding patients with diabetes, who initially presented with a DFU that we healed with laser therapy and the ulcer site remains healed over a decade later:
“Very highly recommended. Professional and knowledgeable and very reasonably priced. Keep up the good work Mr Small.”           J.B. Long Marston