Diabetes related foot ulcers (DFUs) are the main cause of non-traumatic lower extremity amputations. Early multidisciplinary intervention is effective in reducing the rates of adverse outcomes.
A 6 month retrospective analysis (Sept 2012 to Feb 2013) was conducted on patients who attended a weekly combined medical and podiatric high risk foot clinic in Liverpool hospital, NSW.
During the study period, a total of 128 patients identified (2 medical records were missing). From the 126 patients 72% were males and most of them were in the age range of 51-70years (mean ± SD: 63 ± 13.2 yrs). 46% (n=58) patients were newly referred and of these, 65% were referred by specialists while 25% by GP’s. 88% (n=111) had pre-existing diabetes with 74% had diabetes for more than 10 years. 67.5% (n=75) had an HbA1C above 7% (mean HbA1c: 8 ± 2.7 %) but only 34% were known to a specialist service. 91% (n=115) had complicated foot ulcers with 42% due to ischaemia, with 23% having osteomyelitis. A further 41% had peripheral neuropathy. 9% had an active Charcot’s neuroarthopathic process. Staphylococcus aureus and MRSA made the bulk of infective organisms, contributing 27% and 20% respectively. Unfortunately 50% of DFUs failed to heal over the course of the study. 28% of DFUs resolved with conservative management alone with 15% requiring surgical amputations to treat the DFUs.
Patients with active foot ulcers were generally older males with a long history of diabetes that was poorly controlled. The majority were not known to specialist services. While they accessed multidisciplinary foot care, a significant percentage still ultimately required surgical amputation to heal their DFUs. Consideration should be made for interventions targeted prior to the development of ulcers to help reduce rates of amputation.