Putting Feet First – the key role of knowledge, by Scott Cawley


Scott-150x150Scott is Professional Lead Podiatrist for diabetic foot, Cardiff and Vale University Health Board, and one of Diabetes UK’s clinical champions. Here, he talks about the educational role of podiatry in improving diabetes care.

I’ve just given another talk to a GP practice and walking back realise how important our role as podiatrists has become in providing not just education to patients but other health care professionals as well. Education of others might not have been seen as a priority within podiatry previously, yet this couldn’t be further from the truth today: moving away from our traditional nail nipper and scalpel into a teaching role may not, at first, seem the natural way to provide care, but we should remember that ‘transfer of knowledge is care’ and can have a longer-lasting effect.

During talks, when I say ‘your feet are probably the most important part of your body’, I see the realisation on everyone’s faces – as everyday activities either require you to stand, walk or use your feet to carry out sporting activity. So why is it then as a general public we ignore our feet? Unfortunately for patients with diabetes ignoring your feet can have disastrous effects. So education is key! – but needs to be reiterated at every opportunity. Can health care professionals say patients with diabetes don’t listen if they are not informed in the first place on what to do or what to look out for? We know people that have the correct information make better choices and collaborate in their treatments and self care.

So currently across Wales we’ve now started a rolling programme of education and support to ensure that our Primary Care colleagues have the knowledge and understanding to inform their patients’ right at the beginning, on the effects diabetes can have on their feet and how to get into a good foot care routine of observation, allowing them to become co-investigators in their own foot health.

People with diabetes need to be informed early if there’s any risk factors that make them vulnerable to an ulcer or worst an amputation. We now have pathways and guidelines that break these risks into categories.

  • If you have no problems you’re classified as low risk but its important to realise it doesn’t mean ‘NO RISK’, as anyone could damage their foot, but knowing what to do is then fundamental in giving it the best chance to heal.
  • Ten steps to healthy feet, PDF, 272KB

  • If risk factors are identified during your annual foot check then you should be informed of these risks and referred onto the ‘foot protection service’ which is led by the local Podiatry teams working closely with the GP practices, orthotists and community nursing teams. The podiatrists would manage those with increased risk factors often called ‘moderate’ or ’high risk feet’ and will involve further foot health education, with management plans put into place dependent on needs.
    How to spot a foot attack.
  • Any increased risk now makes your foot vulnerable to damage or to getting ulcers, with early signs often presenting as increased warmth, swelling or breaks in the skin of your feet. This is often referred to as a ‘foot attack’ and its essential if you do realise you have a problem like this you contact your GP or foot protection service on the contact number you should have been given. Dependent on your services some ulcers can be managed by the foot protection team but some may also require referral into the ‘multidisciplinary foot service’, where access to vascular, orthopaedic, diabetes consultants and other healthcare professional are available. It’s important you get access to all these services in a timely manner when needed and know how to access them.

Everything I’ve said is important but let’s not forget prevention is better than cure and although we hear a lot about “have you had your feet checked?” perhaps it’s now time to say ‘have you checked your feet to-day?’This is summarised in the Diabetes UK integrated footcare pathway.

Patient information

You can find and order free resources and information to give to your patients on the following topics:

  • What to expect at a foot check
  • 10 Steps to healthy feet
  • How to spot a foot attack (for high risk patients)
  • Further information

    Resources section on diabetes and improving footcare on the Diabetes UK website.
    Find out more about the Clinical Champions programme.

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