The spectrum of missed lower limb clinical findings at a diabetes clinic in KwaZulu-Natal: red flags for costly complications

Abstract

Including a podiatrist in a multidisciplinary team (MDT) has been shown to reduce the incidence of diabetes-related lower limb amputations by at least 56% to as much as 85%. This reflects podiatry’s role in foot screening and assessment, diagnosis, foot treatment, patient education and timely referral in diabetes care. There is no podiatry post at Edendale Hospital, a state health regional hospital in KwaZulu-Natal. What a podiatrist could contribute to the clinical examination, education and treatment of patients living with diabetes (PLWD) attending the Edendale Hospital diabetes clinic was, therefore, unknown. During the last quarter of 2018 and the first quarter of 2019, as part of a research project into peripheral vascular disease, a podiatrist carried out screening, comprehensive foot assessments and observation on 301 outpatients attending the diabetes clinic at Edendale Hospital. Dermatological, musculoskeletal, cardiovascular and neurological presentations found in the patients’ feet and lower limbs were documented. The podiatrist’s assessments and observations were compared with the attending medical doctor’s clinical notes. More than two-thirds of patients (68.1%, n = 205) had an undocumented clinical presentation of lower limb pathologies requiring treatment, in-depth patient education, further investigation and preventive treatment to avoid further costly and debilitating complications. The results of this study support the dire need for podiatry services at a regional hospital level to provide timeous foot care and trained observation skills for PLWD.