Multidisciplinary Teams and Prevention - The Keys to Success for Diabetic Foot Disease
Diabetes-related foot disorders such as ulceration and infection, are leading causes of hospitalization and amputation in the United States and abroad. Peripheral neuropathy, with its associated loss of sensation in the feet, combined with the ever-increasing incidence of peripheral arterial disease place diabetic patients with these complications at high risk for foot ulcers and amputations. Once a person has healed even a minor foot amputation (such as a toe amputation) he/she is at a high risk for future ulceration or amputation. In fact, up to 70% of patients who have healed an ulcer will very likely develop another ulceration within 5 years.
Despite these rather grim facts, there is good news for our patients with diabetes and foot complications! A number of published studies over the last three decades have shown the very positive, and rather dramatic, improvements in outcomes for patients treated in multidisciplinary clinics focusing on diabetic foot care, wound care, and amputation prevention. Studies from the United States, Britain, and throughout Europe have documented up to a forty percent reduction in amputation rates after instituting an organized Diabetic Foot Multidisciplinary Team. Such teams are typically comprised of medical doctors, podiatrists, surgeons, nurses, and footwear specialists all dedicated to amputation prevention. By aggressively treating newly developed wounds according to established international protocols and using advanced therapies as appropriate, patients are most often able to treat their wounds in the comfort of their homes. Early detection and early initiation of treatment is the most successful way to avoid prolonged hospitalization, surgeries, and amputations. Of course, when circumstances require hospitalization, the multidisciplinary team ensures that optimal medical and surgical management is administered according to the latest published guidelines and protocols.
Aside from protocol driven wound care, prevention of new lesions and complications is the key to long term success and reduction in rates of amputation. Also incorporated into the diabetic foot team protocols, prevention includes optimal diabetes management, optimal self-foot care and daily hygiene, appropriate footwear, regular foot examinations and treatment, and patient education. When the patient becomes an integral member of the team and understands the necessity for adherence to good diabetes management and foot care practices, successful prevention of new complications can be expected. In this regard, educating our patients on an ongoing basis becomes an extremely important part of any amputation prevention program.
In future issues we will explore more specific components of established protocols including prevention and management, use of advanced therapies, and new technologies. Stay tuned.