Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

and orthopaedic surgeons (Thomson et al, 1991). In the Italian study the teamincluded a diabetologist, nurse specialist, orthopaedic surgeon, podiatrist, vascularsurgeon and radiologist (Ghirlanda et al, 1997). In the Swedish study the teamcomprised a diabetologist, orthopaedic surgeon, diabetes nurse, podiatrist andorthotist (Larsson et al, 1995). In the London specialised foot clinic the team includeda podiatrist, shoe-fitter, nurse, physician and surgeon (Edmonds et al, 1986). In theprospective Lithuanian study the team included a diabetologist, rehabilitationphysician, podiatrist, orthopaedic surgeon and shoe makers (Dargis et al, 1999).In summary, the common components of the specialist multi-disciplinary team havebeen a physician and podiatrist. Most have also included a specialist nurse andorthotist and all have involved or had ready access to a surgeon.The podiatrist is an essential member of the multi-disciplinary team. Plank et al(2003) evaluated the impact of regular podiatric care on the recurrence rate of diabeticfoot ulcers among 91 people (mean age 65 years) with diabetes and healed foot ulcers.47 people were randomly assigned to the intervention group in which people receivedmonthly chiropodist care, while 44 were assigned to the control group in whichpodiatric care was not recommended. During the median follow-up of 386 days, 18people in the intervention group suffered from ulceration compared with 25 people inthe control group (HR 0.60, CI 0.32-1.09; p=0.09). However, there were fewer feetaffected in the intervention group than in the control group (20 feet v 32 feet, RR0.52, CI 0.29-0.93; p=0.03). There was no significant difference in the location ofulcers between the two groups. Minor amputation was performed in two people in theintervention group and one person in the control group. At the end of follow-up, therewas a significant reduction in overall events of ulceration, amputation and death in thepodiatric care group (18 v 29 events, HR 0.54, CI 0.30-0.96; p=0.03).Further research is required to define the core services in multi-disciplinary carewhich are essential in improving outcomes by reducing the incidence of ulcer oramputation in people with diabetes with high risk feet (Pinzur et al, 1996).87