Leanne Atkin, chair of the Legs Matter campaign, outlines the common causes of non-healing wounds in the lower limbs.
Chronic wounds pose an economic burden to the UK healthcare system, with costs for wound care estimated to be between £4.5bn and £5.1bn per year.1 Research has shown that every year, around 2.2 million people in the UK will develop a chronic wound,1 and these are often linked to other underlying health conditions, including diabetes or oedema. Early diagnosis can help to mitigate the development of chronic wounds so it is vital that both patients and clinicians can recognise the signs and symptoms.
HEQ spoke to the chair of Legs Matter, Leanne Atkin, about how the organisation aims to increase awareness of lower limb conditions and explores the common causes of non-healing wounds.
How did Legs Matter come to be founded? What are your key goals?
The Legs Matter campaign was founded in 2017 and is led by clinicians via a coalition of not-for-profit societies/organisations. Legs Matter continues to be a major influencer for improving lower limb care throughout the UK. The Legs Matter campaign seeks to raise public and clinician awareness of common conditions which can affect the lower leg and/or the foot, highlighting the importance of early healthcare practitioner involvement and the need for accurate assessment and evidence-based interventions.
The campaign is focused on a number of lower limb conditions namely, leg ulceration, peripheral arterial disease, chronic oedema/lymphoedema, and diabetic foot ulcerations. Every day the quality of life for thousands of people is devastated by the lack of support and advice on the prevention of lower leg and foot conditions, and the failure to correctly diagnose and treat them. The Legs Matter campaign was founded to address this.
Legs Matter is committed to:
- Challenging harmful care head-on;
- Stopping the stigma associated with leg and foot conditions;
- Empowering people by raising expectations and knowledge about leg and foot conditions and what good care actually means;
- Working with industry and other like-minded organisations to promote key campaign messages;
- Encouraging experts to join together to have a more powerful voice; and
- Getting everyone – patient to policy-maker – thinking ‘legs and feet’.
The campaign seeks to achieve a fundamental shift in attitudes, treatment, and prevention of leg and foot conditions, creating an environment where like-minded professionals, patients, politicians, and the general public can join together to create a powerful voice to deliver change. Legs Matter’s key advantage is in the strength and credibility of its core coalition. This brings together key people and organisations associated with lower leg and foot conditions within a single-minded environment to drive change.
What are the key challenges affecting the diagnosis and treatment of leg and foot conditions? Has the impact of the pandemic on healthcare services affected the level of support available to patients?
Access to timely and appropriate evidence-based care has always been an issue for many patients. For example: access to podiatry led multidisciplinary teams for patients with non-diabetic foot ulceration; timely assessment/compression therapy for patients with venous disease; access to venous intervention to cure venous hypertension; and access to lymphoedema services for any patients with lower limb swelling.
The pandemic has only made this worse, we have had stories of patients with severe limb ischaemia having four telephone GP appointments over a four-week period, resulting in the patient being inappropriately managed with antibiotics and analgesia, where this patient needed an urgent referral to the vascular team and acute revascularisation. This delay in appropriate management is risking patients’ lives and legs.
What are some common causes of non-healing wounds of the leg and foot? Are any specific demographics more at risk?
The Legs Matter campaign covers a wide variety of lower limb conditions, but the most common cause of non-healing lower limb wounds is related to venous insufficiency, where the veins are unable to return the blood to the heart as they should. This results in back pressure within the venous system, so the blood products leak into the surrounding skin causing swelling (oedema), brown staining (hemosiderin staining), and internal inflammation which can result in skin breakdown and ulceration.
Lower limb ulceration is common and is thought to affect over one million people in the UK.3 The annual cost to the NHS from treating patients with venous leg ulcers and associated comorbidities is estimated to be £941.1m.3 Venous leg ulcers account for around 910,000 GP visits, 450,000 hospital visits, and 107,000 day case admissions in the UK.4
The patients who are most at risk of developing venous ulceration are those patients with a related family history, increased BMI, and are more common with advancing age. However, anyone could suffer from a venous leg ulceration, as often the issue with the veins refluxing is that it cannot be seen on the outside of the leg. The key is if a patient has a knock or a sore on their leg then they need to undergo an assessment to determine whether there is a problem with the veins.
Are there preventive or protective measures that can be taken to lessen the risk of developing leg or foot problems?
Just like with most health issues the three main components to lessen the risk is to adopt a healthy lifestyle. This means not smoking, regular exercise, and maintaining a healthy BMI.
Considering the cost of managing unhealed wounds is substantially greater than that of managing healed wounds, what further action could be taken at a policy level to improve the support for those with leg and feet conditions?
We need policymakers to understand the urgency related to lower limb ulceration. With appropriate assessment and commencement of evidence-based care, 86% of venous leg ulceration can heal within 12 weeks.5 However, the reality in the UK is that we are only healing 37% of patients after 12 months of therapy. This is simply related to the unwarranted variation in the UK wound care services, but this offers major opportunities to improve healing rates and thus reduce patient suffering, reduce spending on inappropriate and ineffective treatments, and the amount of clinical time spent on wound care.
We need the clinical workforce to stop simply managing these wounds but to focus on healing, ensuring that patients have access to evidence-based care within two weeks of ulcer recurrence – this way the burden of chronic ulceration to the NHS and to the patient themselves would be massively reduced.
- Guest, J.F., Burden of wounds to the NHS: what has changed since 2012/13? Wounds UK, 2020. 17(1): p. 10-15.
- Dogra S, Sarangal R. Summary of recommendations for leg ulcers. Indian Dermatol Online J. 2014 Jul;5(3):400-7. doi: 10.4103/2229-5178.137829. PMID: 25165685; PMCID: PMC4144253.
- Gohel, M.S., et al., A Randomized Trial of Early Endovenous Ablation in Venous Ulceration. New England Journal of Medicine, 2018. 378(22): p. 2105-2114.