Up to a tenth of people with diabetes will develop a diabetic foot ulcer at some point – and of those, as many as half will die within five years.
These stark figures are a reminder of the importance of podiatry – care of high-risk foot, ankle and leg problems – as well as the need for research to improve treatment and practice.
The podiatry service at Bury Care Organisation covers both community and hospital care and has around 150 referrals a month, dealing with diabetic foot ulcers, peripheral arterial disease, musculoskeletal foot pain and nail surgery.
Operational lead James Linsley has been developing his own research experience since completing a service evaluation on X-ray referrals of osteomyelitis (an infection in the bone beneath a diabetic foot ulcer) during his MSc. The project’s findings, published in the Diabetic Foot Journal, reinforced the need for early antibiotic intervention in patients where clinical infection is present to improve outcomes, and the importance of a thorough justification for X-ray. Other areas were also able to use the evaluation to benchmark their own services.
Since then, he’s been involved in several quality improvement initiatives, including work to reduce DNA (did not attend) rates, as well as publishing case reports and leading educational events.
Most recently James and the 10-strong team have been part of a multi-centre evaluation of two different gelling-fibre dressings designed to manage wound exudate levels and promote moist wound healing. The results have been published in the Journal of Wound Care.
In addition, they are recruiting patients to the Domino-DFU study which is aiming to improve the diagnosis of osteomyelitis, as well as conducting an audit of healing rates after nail surgery.
James explained: “We have a caseload of around 3,000 patients and have 40-minute appointments with people with high-risk foot problems, so we are well-placed to offer research opportunities. We find our patients are very receptive to the idea of getting involved – they’re keen to try anything that will help.
“We see patients in the community in Bury and at Fairfield General Hospital and also work collaboratively with colleagues in Salford, so we can refer patients to studies that are open there. That includes working with other departments as well as podiatry, where we have interests in common. For instance, there’s a study looking at exercise for people with diabetic foot ulcers – as podiatrists, we would advise these patients to keep off their feet if they can but that limits their exercise opportunities and has repercussions for their cardiovascular health.”
He added: “Research is interesting in itself but more importantly, it really benefits the service, improving care for patients and offering new opportunities for learning to the team.”