Association of British Clinical Diabetologists (ABCD): survey of specialist diabetes care services in the UK, 2000. 3. Podiatry services and related foot care issues

Authors


: P H Winocour, Consultant Physician, Department of Diabetes and Endocrinology, Queen Elizabeth II Hospital, Howlands, Welwyn Garden City, Herts AL7 4HQ. E-mail: peter.winocour@qeii.enherts-tr.nhs.uk

Abstract

Aim To examine the provision of, and variations in, podiatry and other services for diabetic foot care in the UK.

Method A postal survey of secondary care providers of diabetes services in the UK in 2000.

Results Following two reminders a 77% response rate was achieved. The responses indicated that 97% had a state-registered podiatrist attached to the service, providing three (median) sessions each week for diabetes care, although only 44% had availability at all diabetic clinics, and only 3% had availability at paediatric diabetic services. Podiatry access at all diabetic clinics increased the likelihood of associated preventative as opposed to reactive (‘trouble shooting’) care (P < 0.05). All individuals with feet at ‘high risk’ of ulceration had access to ‘at least 2 monthly review’ in 15% of trusts, and with active foot ulceration at least weekly in 43%. Over 70% used at least one form of equipment to assess peripheral neuropathy, but peripheral blood flow was only formally measured in 13%. Although podiatry input to patient education was common (84%), only 6% had received formal training in education. Guidelines and strategies for management of active foot problems were available in 50−74% of cases. Orthotic input was highly variable, and absent in 15% of responses. Podiatrist fitting and application of foot protective apparatus was only recorded in 22−61% of responses. Access to isotopic and/or MR foot imaging and peripheral angiography and angioplasty was recorded in 75−83% of responses. Separate specialist foot clinics were available in 49%, and where this was the case the use of newer foot ulcer healing applications was higher (P < 0.01). Clear regional differences were apparent in the nature of the service, the use of newer treatments, and in access to an orthotist, a local ‘dedicated’ foot surgeon or a separate diabetic foot clinic. Of 245 documented bids for service improvements, only 19 related to foot care and only 21% of bids were successful.

Conclusions Despite an increase in podiatry support to diabetes care over the last 10 years, the level of access and the nature of the services provided is much less than recommended in many advisory documents. The strategy of a co-ordinated ‘team’ approach to foot care still takes place in less than 50% of centres. There are clear regional differences in diabetes foot care services. Both providers and purchasers of diabetes services may not have given sufficient attention to this area, given the relatively small number of documented bids for service improvements in this area, and the very low success rate of such bids.

Ancillary