One of the most effective strategies for managing diabetic foot ulcers is implementing a multidisciplinary approach, which involves coordinated care from various healthcare professionals.
This approach has been shown to:
- Improve patient outcomes significantly.
- Reduce the incidence of amputations.
- Enhance the quality of care that is provided to diabetic patients.
In this article, we will list the benefits of adopting a multidisciplinary approach to diabetic foot ulcer treatment and review a case study that discusses this matter in detail.
Diabetic foot ulcers – An overview
The treatment of diabetic foot ulcers is complex as these ulcers commonly result from multiple factors. For instance, peripheral neuropathy affects up to 50% of diabetic patients, which reduces sensation in the feet and causes unnoticed injuries and ulcers. [1]
On the other hand, peripheral artery disease limits blood flow to the extremities, which obstructs the healing process and increases the risk of infection.
Aside from these factors, immunosuppression makes patients more susceptible to infections that can quickly escalate and result in sepsis. Keep in mind that most patients who live with diabetes for a long period of time are relatively immunocompromised (weakened immune system). [2]
The benefits of a multidisciplinary approach
A multi-disciplinary approach to diabetic foot ulcer treatment involves the collaboration of various specialists, including podiatrists, orthopaedic surgeons, vascular surgeons, plastic surgeons, endocrinologists, infectious disease specialists, physiotherapists, and diabetes educators.
This ensures that all aspects of the patient’s condition are addressed, which improves outcomes and significantly reduces the risk of severe complications.
1. Reduces the risk of amputations
One of the most significant benefits of a multidisciplinary approach is improving healing rates and reducing amputations. Studies have demonstrated that implementing a multidisciplinary team can decrease the incidence of major amputations.
For instance, a review of 33 studies found that 94% of the studies reported a reduction in major amputations (i.e. below-knee amputation) after establishing a multidisciplinary team. [3]
The comprehensive care these teams provide ensures that all contributing factors, such as diabetes control, local wound management, vascular disease, and infection, are addressed promptly and coordinated.
In a recent study that investigated the clinical benefits of adopting a multidisciplinary approach in managing diabetic foot ulcers, researchers found that the outcomes of patients are further improved when ortho-plastic surgery (a combination of orthopaedic and plastic surgeries) is incorporated. [4]
Here are the findings of this study:
- Team effort: The treatment of diabetic foot wounds effectively requires a team of specialists, including reconstructive surgeons, who play a critical role in the prevention of amputations.
- Limb salvage: The approach prioritizes limb preservation over amputation and addresses all aspects of the condition. This includes blood flow issues, infections, and the correction of any foot deformities.
- Better quality of life: The use of these combined methods benefits patients by allowing them to maintain mobility and improve their quality of life. They also lower the incidence of complications and the risk of recurrences.
- Complexity and customisation: Each case is complex and requires tailored treatments that include careful management of blood sugar levels, proper wound care, and strategic surgical and non-surgical interventions that consider the entire foot’s condition.
2. Provides coordinated care
The coordinated care provided by the multidisciplinary approach is extremely valuable. Timely interventions can prevent the progression of ulcers and lower the need for amputations. This is one of the key factors that makes such an approach so effective.
Here’s the specific role of each specialist:
- Regular assessments, wound debridement, and offloading by a podiatrist to manage the foot ulcer.
- Vascular surgeons will assess your feet to ensure adequate blood flow.
- Adjustments in diabetes medications by an endocrinologist to maintain optimal blood glucose levels.
- In cases where infection is present, an infectious disease specialist can provide targeted antibiotic therapy to control the infection and prevent its spread.
3. Educate the patient about their condition
Patient education is another central element of the multidisciplinary approach. Healthcare professionals will teach patients about proper foot care, the importance of glycemic control, and the early signs of foot complications. This can significantly reduce the risk of developing foot ulcers.
You can learn how to detect a potential foot ulcer in this article.
The role of technology in the multidisciplinary approach to foot ulcer treatment
It’s true that the success of a multidisciplinary approach largely depends on the expertise and collaboration of the team members. However, the appropriate tools and technology can also significantly improve patient outcomes.
For example, advanced wound care products, such as negative pressure wound therapy and specialized dressings, promote faster healing and reduce the risk of infection.
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A case study
A retrospective cohort study conducted at the Gosford Hospital High-Risk Foot Clinic in Australia provides a clear example of the benefits of a multi-disciplinary approach to diabetic foot ulcer management. [5]
The study compared patient outcomes before and after implementing a multidisciplinary team. The results showed a significant reduction in the median time to ulcer healing, from 20.4 weeks in 2017 to 14.2 weeks in 2019.
Additionally, the percentage of ulcers that healed within 52 weeks had increased by 10.1%. The number of vascular interventions had also increased by 17.4%, which shows how this approach effectively identifies at-risk patients early and manages them before they worsen.
The table below showcases the significant improvements in patient outcomes after the implementation of a multi-disciplinary team (MDT). [5]
| Outcome | 2017 (before MDT) | 2019 (after MDT) |
| Median time to ulcer healing | 20.4 weeks | 14.2 weeks |
| Percentage of ulcers that healed | 58% | 68% |
| Incidence of vascular interventions | 1.6% | 19% |
Takeaway message
Due to the complexity of the condition and the multiple factors contributing to its development and progression, the treatment of diabetic foot ulcers requires a comprehensive and coordinated approach. A multidisciplinary approach involves collaboration between various specialists to improve patient outcomes, reduce the risk of amputations, and enhance the quality of care.
Multidisciplinary Diabetic Foot Team in Singapore
At Straits Podiatry, we understand the importance of adopting a multidisciplinary approach to managing diabetic foot complications. Therefore, we have a well-coordinated diabetic foot team of podiatrists, orthopaedic surgeons, and other specialists who strive to provide you with efficient, tailored care.
We hope this article helped you appreciate the significant role of a multidisciplinary approach in diabetic foot treatment.
If you suspect that you may have a diabetic foot ulcer, schedule an appointment with our diabetic foot team today.
If you have any questions about our multidisciplinary approach to diabetic foot management, feel free to check out via this link (insert).
References
- https://emedicine.medscape.com/article/1170337-overview
- https://pubmed.ncbi.nlm.nih.gov/31657690/
- https://www.researchgate.net/publication/336993156_A_systematic_review_of_multidisciplinary_ teams_to_reduce_major_amputations_for_patients_with_diabetic_foot_ulcers
- https://www.sciencedirect.com/science/article/pii/S2666769X24000010
- https://pubmed.ncbi.nlm.nih.gov/38379247/
