Improved Survival of the Diabetic Foot: The Role of a Specialised Foot Clinic

TLDR

Diabetic foot ulcers frequently present as neuropathic callus‑associated lesions or ischemic necrotic areas, and prior to the clinic there were 11–12 major amputations per year. The clinic employs a multidisciplinary team—chiropodist, shoe‑fitter, nurse, physician, surgeon—using custom footwear, intensive chiropody, and targeted antibiotics to treat neuropathic and ischemic ulcers. The clinic achieved 86 % healing of neuropathic ulcers and 72 % of ischemic ulcers, reduced relapse to 26 % with special shoes versus 83 % with self‑chosen footwear, and cut major amputations from 11–12 to 5–7 per year.

Abstract

A specialised foot clinic for diabetic patients has made a detailed analysis of the presentation of diabetic foot ulcers and from this a new, organised approach to treatment has been derived. Over three years it has achieved a high rate of ulcer healing and reduced the number of major amputations. It has brought together the skills of chiropodist, shoe-fitter, nurse, physician and surgeon to manage the distinctive lesions of the neuropathic and ischaemic diabetic foot. The neuropathic ulcer was invariably associated with callus, whereas the ischaemic ulcer presented as areas of necrosis often from localised pressure of light shoes. Essential aspects of management are specially constructed shoes, Intensive chiropody and precise antibiotic treatment. Healing was achieved in 204 out of 238 (86 per cent) neuropathic ulcers and 107 out of 148 (72 per cent) ischaemic ulcers. Relapse rate in special shoes was 26 per cent compared with 83 per cent who preferred to wear their own shoes. In the two years before the establishment of the clinic, there were 11 and 12 major amputations yearly. This rate has now been reduced to seven, seven and five amputations yearly.