1. Chu, Julie MSN
  2. Singh Joy, Subhashni D.

Article Content

According to this study:


* A clinic focused on preventive care and wound management decreased the need for lower-extremity amputations as a result of diabetes mellitus.


In an effort to prevent diabetes-related amputations, a medical center in Birmingham, Alabama, established a foot care clinic. The clinic was staffed by certified wound, ostomy, and continence nurses; infectious disease specialists; and internal medicine physicians who consulted with surgery specialists. The clinic was open a half day every week to referral patients only.


Patients received physical examinations that included foot inspection and assessment for loss of protective sensation, which increases the risk of wounds caused by ill-fitting footwear. Risk was assessed with a scale that incorporated self-reported history and examination results. This risk rating determined the level of education and care each patient received. Wounds were measured, photographed, and treated. Patients received nail and callus debridement, referral to pedorthists for footwear, and education, including repeated reminders on how to care for their feet at home. Patients returned every one to two weeks if they had wounds or every three to six months for foot assessment and inspection of shoes and inserts.


Clinic physicians saw 679 patients in 2004, 90% of whom had some loss of protective sensation. More than half of the patients (65%) had the highest rating on the risk assessment scale, indicating foot deformity, calluses, a loss of protective sensation, and a history of at least one extremity wound. After the clinic was established, hospital admissions for lower-extremity amputation decreased from 1.8% in 2000 to 0.5% in 2004.


In addition to decreasing the number of amputations, this dedicated foot care clinic decreased hospital costs and indirectly increased revenue with increased referrals for diagnostic services.-SDSJ


King LB. J Wound Ostomy Continence Nurs 2008;35(5):479-82.