What is Foot Diabetes?
Diabetes is a serious problem in the UK but there is an acute serious condition called ‘diabetic foot’ which if left undiagnosed can result in a claim for compensation for diabetic foot. The consequences of not being referred by you General Practitioner (GP) in time could be catastrophic to include:
- Charcot foot
- Blindness
- Renal failure
- Amputation of lower limbs
- Death
- Infections
- Osteomyelitis
- Sepsis
Diabetic foot may occur when a person suffers from diabetes mellitus that may turn into a condition also known as charcot foot. The damage caused by a diabetic foot results in damage to the nervous system, when a person has high blood sugar levels, the high blood fats and high blood pressure can damage the small blood vessels that supply the nerves. Over time their nerves throughout the body are damaged or can even disappear. Damage to the nervous system ‘neuropathy’ will result in feeling no symptoms of pain and you will continue life as normal until the joints and bones may begin to change shape. Once this occurs you may run the risk of developing a foot ulcer and possibly amputation following progression of the disease.
The major problem with a delay in detecting charcot foot is that you simply carry on life as usual unaware of the damage you are causing yourself. That is because the effect of continuing to put weight on the foot during the inflammatory phase (exacerbated by the lack of awareness caused by neuropathy) is that it leads to a progressive destruction of the bones. The foot may become flatten and, eventually, become convex – a so-called rocker-bottom foot.
Can I Sue My GP for Diabetic Foot?
If you saw your GP in good time but your GP failed to make a diagnosis of diabetic foot, the delays may result in serious injury to you. As with most medical conditions, if symptoms are detected and treated early your outcomes of recovery are much improved. Diabetic foot is a limb-threatening or life-threatening and therefore a serious condition that must be treated with urgency.
Examples of such conditions are:
- Ulceration with fever or any signs of sepsis.
- Ulceration with limb ischaemia (see the NICE guideline on peripheral arterial disease).
- Clinical concern that there is a deep-seated soft tissue or bone infection (with or without ulceration).
- Gangrene (with or without ulceration).
The NICE guidelines for diabetes foot provides detailed advice for GPs on what to do in particular the GP must refer any suspect diagnosis of diabetes foot within 1 WORKING DAY to a specialist multidisciplinary foot care team.
A multidisciplinary foot care team will comprise of various experts such as:
The local multidisciplinary diabetes foot care team (MDFT) consists of:
- Diabetes specialist
- Diabetes specialist nurse
- Orthopaedic surgeon
- Vascular surgeon
Therefore any delay that may cause a deterioration in your diabetic foot condition that has resulted in further injury and pain may be able to sue the GP for compensation. However it is important that even if early diagnosis and referral is made by your GP it may not mean you can sue for compensation. A very careful analysis by our clinical negligence team will be able to advise you if a claim can indeed be made.
Diagnosis of Diabetes Foot
In the NICE guidelines, a diagnosis has been summarised below,
Assess people for the presence of peripheral arterial disease if they:
- have symptoms suggestive of peripheral arterial disease or
- have diabetes, non‑healing wounds on the legs or feet or unexplained leg pain or
- are being considered for interventions to the leg or foot or
- need to use compression hosiery. [2012]
1.3.2 Assess people with suspected peripheral arterial disease by:
- asking about the presence and severity of possible symptoms of intermittent claudication and critical limb ischaemia
- examining the legs and feet for evidence of critical limb ischaemia, for example ulceration
- examining the femoral, popliteal and foot pulses
- measuring the ankle brachial pressure index (see recommendation 1.3.3). [2012]
1.3.3 Measure the ankle brachial pressure index in the following way:
- The person should be resting and supine if possible.
- Record systolic blood pressure with an appropriately sized cuff in both arms and in the posterior tibial, dorsalis pedis and, where possible, peroneal arteries.
- Take measurements manually using a doppler probe of suitable frequency in preference to an automated system.
- Document the nature of the doppler ultrasound signals in the foot arteries.
- Calculate the index in each leg by dividing the highest ankle pressure by the highest arm pressure. [2012]
As can be seen there are various factors that must be considered to determine a diagnosis of diabetes foot. But importantly the GP will be aware of your history of diabetes and as a matter of routine would and should advise you to regularly check your fee for even minor cuts and bruises.
Allegations against GPs for not diagnosing diabetes foot
The important point is that the GP has failed to follow the NICE guidelines above. On a general point the arguments against the GP that solicitors will claim on behalf of their client are:
- Failure to detect diabetes foot in time or at all.
- Failure to treat signs of infection.
- Failure to recognise the importance of foot health in diabetics.
- Failure to recognise potential dangers of even seemingly minor foot lesions.
- Failure to familiarise themselves with the correct entry pathway.
- Failure to refer to the correct agency.
- Failure to refer urgently (in accordance with NICE NG12).
- Failure to adequately monitor the progression of the condition.
- Failure to give adequate safety netting.
It is important to note that diabetic foot or neuropathy reduces your ability to feel pain and therefore are unaware of the initial damage. Therefore minor things such as a blister may become affected and cause greater injury, left untreated may result in permanent or serious disability or even amputation.
The GP will be or should be aware of such complications as this is a common potential problem when a patient has diabetes. The GP should consider questioning the patent more and perhaps would recommend regular check ups of the feet to establish any problems to aid diagnosis of diabetes foot.
Again failure to undertake one or more of the above assessments may result in your GP being negligent and compensation may be paid to you for the additional pain and suffering.
How Much Compensation for diabetes foot?
Due to the possible seriousness of the delayed referral by your GP the compensation can be substantial.
Below are just a few guidelines on compensation for diabetes foot.
Amputation of both feet to £190,000
Amputation of one foot to £103,000
Very Severe or permanent injury to foot to £66,000
Serious injury affecting mobility to foot £37,000
Displaced fractures to foot £24,000
The above compensation figures are for the injuries alone. If you were forced to give up work then you can also claim for loss of earnings, care, medical expenses, home improvements if you are unable to climb stairs and many other possible items to claim.
