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Podiatry's role in managing long term conditions

Podiatry’s role in managing long term conditions

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By Dr Michelle Spruce

    

Last week as part of Foot Health Month, the College of Podiatry focused on sport and the role podiatrists play in keeping people active.

You may have noticed that it was also national Diabetes week, which serves as a useful reminder of another really vital part of a podiatrist’s caseload – that of helping to identify and manage conditions affecting less active people. So, right on cue, this week in Foot Health Month the focus is podiatry and long term conditions. I’ve been invited to share some of my thoughts on this topic. 

The feet are an incredibly complex part of the body and we need to look after them for a whole host of reasons. It’s amazing how quickly our overall health can deteriorate if bad foot health keeps us out of action for a sustained period. For people with long term conditions, such as diabetes, rheumatoid arthritis, vascular disease or musculoskeletal problems, the feet are a lifeline – helping to maintain mobility and independence. But these patients also face particular challenges with complications affecting their feet and lower limbs. 

My particular area of expertise is diabetes, and if we take that condition alone, there are some staggering statistics about the impact it can have. Did you know, for example, that diabetes is the leading cause of foot and lower limb amputations, and a person with diabetes is 23 times more likely to have a foot amputation than the population as a whole? Amputations are largely the result of non-healing foot ulcers which get infected and the surrounding tissue becomes gangrenous (necrotic). The causes of diabetic foot ulcers are complex and often interlinked. They include damage to nerves (peripheral neuropathy), occluded arteries (peripheral arterial disease), trauma and excessive foot pressures. 

Sadly, lower limb ulcers and amputations are linked with high mortality. The mortality rate for diabetic foot ulcers is third only to pancreatic and lung cancers at 5 years. Up to 70% of those who have undergone an amputation die within 5 years.

For this reason the College of Podiatry advises that people with diabetes have their feet screened annually by a suitably trained healthcare professional. With an estimated 4.6 million people across the UK currently living with diabetes (a number that is growing as the population ages) – that’s a lot of foot health checks. But the costs to the NHS of diabetic foot complications is estimated at £1.1-£1.3 billion a year, so investment in preventative care could generate big cost savings as well as preventing needless amputations. 

Podiatrists play a key role in addressing these issues. Unfortunately, over the last few years in many parts of the country, it has become harder for patients to see a podiatrist on the NHS , meaning many people are now having to fund their own care through private healthcare. The diabetic caseload for independent podiatrists is increasing – in my own practice we found we had proportionally more patients with diabetes than we would expect to find in the general population. It is essential that these patients find a registered podiatrist because podiatrists are the only profession to be fully regulated by the Health and Care Professions Council (HCPC) and recognised by the NHS as experts in all aspects of the lower limb. Their wider knowledge of the whole lower limb and systemic health issues enables them to identify issues early and refer on appropriately. 

In our role as podiatrists we work together with our patients as the first line of defence for many long term conditions. This allows us to flag issues as they arise and refer to the necessary specialists, in line with NHS and NICE guidelines.

In one such case, I saw a patient who reported cramping pains in their lower leg, and very red skin that was cold. This suggested possible symptoms of a major circulation problem (blood clot), so I sent that patient straight to A&E, where they were admitted and received urgent treatment. Most often, the interface with the NHS is through GP referrals. It makes a huge difference for a registered podiatrist to do this, as opposed to a less qualified health practitioner, because our training and deeper knowledge of general health means we speak a language that GPs can relate to, ensuring better ongoing treatment for our patients. 

Another important part of my work with patients with diabetes is in falls prevention. Patients with peripheral neuropathy – a loss of sensation in the feet that is common in diabetic patients – are vulnerable to losing stability. Podiatrists can give exercises to help maintain core stability, as well as advice on the use of mobility supports which are vital to keeping people on their feet. In one case I saw was a lady who used a beautiful old walking cane. I asked her about it and she said it belonged to her great uncle – who was about 6ft 2in! As the lady in question was a little over 5ft the device was doing more potential harm than good, so I’m glad to say we sorted out a better alternative that was appropriate to her height. 

With an ageing population, conditions such as diabetes will grow in prevalence, creating huge demand for podiatrists. Whether in the NHS or independent practice, as podiatrists we all have a vital job to do to help people manage their conditions, avoiding some of the complications that can ruin lives and cost so much to the health service.  

   


    

Michelle Spruce is a HCPC registered podiatrist and the owner of the Blandford Podiatry & Chiropody Surgery in Blandford Forum, and Wareham Foot Clinic, Wareham, Dorset. She has a PhD in the links between small vessel circulation and the development of diabetic foot ulcers. 




Suggested tweets: #FootHealthMonth2018 

How does #podiatry support long-term conditions such as #diabetes #rheumatoidarthritis #vasculardisease and #musculoskeletal problems? www.scpod.org/long-term-conditions  #FootHealthMonth2018

#Podiatrist Dr Michelle Spruce, an expert on #diabetes, explains the vital role of #podiatry in supporting people with long-term conditions www.scpod.org/long-term-conditions  #FootHealthMonth2018