Advanced Podiatry Care in the Diabetic Population - Part II

Objective: To identify and study barriers in the healthcare system related to diabetic foot screening and risk stratification.

Methods: A literature review and review of internal data was used to identify effective diabetic amputation prevention strategies and barriers to these strategies. A survey was developed to determine the extent to which components of PCP-administered diabetic foot exams identify known amputation risk factors. The survey was completed by 149 PCPs in Massachusetts and 639 PCPs nationally.

Results: The literature suggests that effective prevention strategies include multi-component, interdisciplinary programs using standardized guidelines. All people with diabetes should receive an annual foot exam and those at higher risk be referred to a foot specialist for more frequent and thorough examinations. In MA (response rate=78%), <2% of PCPs reported routinely performing all foot exam key components and 29% (95%CI 21-35) do not include any. Results were similar across all surveyed states (response rate 71 - 82%). The most common component was the vascular examination (40%), the least common was musculoskeletal (8%). The mean number of key components performed was 1.13. Most PCPs felt somewhat comfortable with performing a diabetic foot exam, however, this was not associated with the number of key components performed (P=0.69) or with referral reasons (P=0.45). The most common reason for referral to a foot specialist was for a foot ulcer (78%, 95%CI 71-85).

Conclusions: According to these survey results, preventative foot exams do not routinely include key components that would identify risk factors that lead to foot ulcer and amputation.