Vigilance the price of freedom from diabetes-related foot disease: podiatrist

feetDiabetes-related foot disease results in about 27,000 hospitalisations, 4,400 amputations and nearly 1,700 deaths in Australia each year.

The sobering statistics and the associated cost to both individuals and the healthcare system emphasise the need for better prevention, the Australia Diabetes Educators Association (ADEA) Queensland branch conference was told.

Brisbane podiatrist Scott Lucadou-Wells, from Wound Innovations, said the latest available data, admittedly from 2004, showed only 50% of people with diabetes received an annual screen for foot disease.

Yet without early identification and management, the risk of complications and recurrence were high.

“I think screening is most important. We need to make sure they have a palpable foot pulse and they can feel a monofilament beneath the foot. If clinicians are sensing anything out of the ordinary then they need to refer to a podiatrist,” he told the limbic.

“The neuropathy is often what drives it, the person can’t feel their feet and often the footwear, constructed specifically to take the pressure off that area, isn’t in place.”

He said foot ulcers were serious and needed to managed immediately – preferably within 24 hours. However the reality was some patients were not being seen for up to two weeks.

An Australian Diabetes-Related Foot Disease Strategy 2018-2022 has laid out plans to improve access to affordable, effective and quality care.

He said a national research agenda supported by funding proportionate to the impact of diabetes-related foot disease was also urgently required.

“40% of ulcers recur within one year and then, out to about five years, it is about 70% so most of them recur and often that is because the causative factor is still there.”

“So if they’ve had a foot ulcer, they go into a high-risk category and they stay there. Also if they’ve got peripheral arterial disease or neuropathy, plus or minus a deformity.”

“The recommendation is for at least 3-monthly reviews and then gradually extending the intervals.”

He admitted the hardest part of the equation was sometimes behaviour change – encouraging the patient to be diligent about wearing prescribed footwear.

“All those things need to be in place to prevent that wound from coming back.”

He said enlisting the support of partners or carers to monitor the soles of the patients’ feet and ensure there were no foreign objects inside footwear was helpful.

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