Diabetic Feet

Dr. Vivienne Moult has a special interest in diabetic foot problems, and is very experienced in managing them and working as part of a multi-disciplinary team of experts to help you recover and get ‘back on your feet’. 

When an operation or amputation is required to treat a serious diabetic foot infection, Dr. Vivienne is passionate about looking at the 'big picture' to provide you with a functional foot, a wound that has the best chance of healing and the forward planning to help avoid future neuropathic ulcers. 

Diabetes is a serious condition, and when poorly managed is known as the 'silent killer' - as patient's often feel fine and have no symptoms, all the whilst tissue damage is silently occurring. Patient's often remain unaware until signs of end-organ damage start to appear such as peripheral neuropathy, kidney disease (nephropathy), eye problems (retinopathy), or diabetic foot problems. 

Diabetic neuropathy (nerve dysfunction) leads to several problems which all contribute to causing a foot that is high risk of developing ulcerating which can be life or limb threatening. 

A sensory neuropathy begins distally and moves proximally eventually involving the entire foot - this means that patient's are unable to feel when they have sustained an injury (eg. standing on a thumb tack or a splinter). 

Motor neuropathy (nerve that supply the muscles) results in muscle wasting and weakness to the intrinsic muscles of the foot, a resultant imbalance then occurs as the long tendons are no longer balanced by the intrinsic muscles. This leads to deformities of the foot such as hammer-toe/ clawing of the toes, and subluxation of the joints to the toes just to name a few - this then leads to adnormally increased areas of focal pressure on the foot which are at high risk of ulceration. 

Autonomic neuropathy results in an absence of sweat production which leads to dry scaly skin and increases the likelihood of cracks and fissures which can lead to infection. Autonomic neuropathy may also lead to localised areas of shunting (abnormal capillary blood flow) and impaired microvascular regulation of the skin - all of which further contributes to the increased risk of ulceration and poor healing. 

Diabetes also affects the arteries that supply blood to the foot. Commonly people with diabetic neuropathy will suffer from very significant arterial disease, which could be anywhere in the arteries of the legs but tends to particularly affect the small arteries below the knee to the foot (tibial arteries). This further contributes to poor healing and may result in uncontrolled infection. 

Charcot Neuropathy is a serious condition which results destruction of the bones in the middle of the foot (midfoot) leading to collapse of the arch of the foot with resultant deformity. This is a serious condition that if suspected requires urgent specialist attention and care within a multi-disciplinary team in order to aggressively treat to try to prevent the progression and deformity. 

Dr. Vivienne Moult will perform a complete assessment of your foot to determine the cause of the ulceration. The blood supply to the foot is assessed to ensure it is adequate for healing, and if required revascularisation is performed. A complex wound care plan is developed and reviewed at frequent intervals. Any identified cause for ulceration (eg. pressure) is assessed and managed, and you will be educated on preventative footcare for the future. Dr. Vivienne Moult will liaise with your GP or primary healthcare provider to ensure they are kept up to date every step of the way.