Diabetic Foot Service Facilities Help Avoid Amputations

A new study suggests that providing more effective foot care services results in reduced major diabetes-related lower limb amputation incidence.

Researchers at South West Clinical Network (Bristol, United Kingdom) conducted a study to investigate the relationship between diabetes-related lower limb amputation incidence and foot care services in the Southwest region of England. The study examined ten key elements of foot care services, such as administrative support, standardized general practice foot screening, improved community podiatry staffing, hospital multidisciplinary foot clinics, effective care pathways, availability of an orthoptist and audit. Delivery of service provisions was compared to major amputation incidence in other regions.

The results revealed that initial (2013) diabetes-related major amputation incidence correlated inversely with adequate delivery of diabetes foot care services. Repeat reviews conducted in 2015 found that two or more service improvements were reported by six diabetes foot care providers, with introduction of more effective service provision resulting in significant reductions in amputation incidence. Conversely, failure to improve unsatisfactory service provision resulted in continued high amputation incidence. The study was published on October 11, 2017, in Diabetes Medicine.

“It is not possible for us to quantify the contribution of each separate service provision to reduction in major amputation incidence; however, the provision of a multidisciplinary foot clinic with less than five of the other key services was not sufficient to reduce high major amputation incidence,” concluded lead author Richard Paisey, MD, of Torbay Hospital (United Kingdom), and colleagues. “Based on these findings we strongly recommend robust commissioning to provide and coordinate ten key service provisions for diabetic foot care in all Clinical Commissioning Groups.

Diabetes patients often suffer from nerve and circulation problems in the feet, which reduce their perception of pain. The nerve pathways that ensure that weight is automatically transferred from one foot to the other during prolonged standing are disrupted, and as a result, diabetics do not notice that their toes, heels, or the balls of their feet are too heavily loaded. The foot receives no relief, and pressure sores, ulcers, and infections may go unnoticed. Serious cases may even lead to amputation.

Related Links:
South West Clinical Network
Torbay Hospital