EDFN calls for foot data from first COVID-19 wave

Podiatry teams are being encouraged to submit data to see how the first wave of the COVID-19 pandemic impacted the health of people with diabetes and inpatient multidisciplinary foot teams (MDFT) workload.

The request comes as figures from the Royal Free Hospital has revealed there was a spike of diabetes-related foot cases peaking in June and July 2020, which was not seen the previous year.

The inpatient audit data showed the top six diagnosis categories for foot pathology were identical throughout 2019 and 2020 (Neuropathic Ulceration with infection, Neuroischaemic Ulceration, Ischaemic Ulceration, Neuroischaemic Ulceration with infection, Ischaemic Ulceration with infection and Osteomyelitis). However the severity of foot conditions requiring admission to hospital increased rapidly after the UK’s first lockdown, mostly in conditions of ischaemia.

The English Diabetes Footcare Network (EDFN) now wants to see whether this pattern is representative across the rest of the country, with podiatry teams being asked to submit any available data.

Network Chair Professor Richard Leigh, who is also a Consultant Podiatrist at Royal Free London NHS Foundation Trust, said: “Having looked at our figures, there’s no doubt that the first COVID-19 wave had a significant impact on foot health among patients in our patch.

“I think there’s been a number of reasons why acute foot conditions increased at our hospital at the end of the first COVID wave. Firstly, many people with diabetes self-isolated and therefore did not medical help when a foot problem first arose and others simply didn’t realise that hospital foot clinics were still running.

“Many elective surgeries were cancelled, particularly in vascular services and Community Foot Protection Teams (FPTs) clinics were taken over and replaced with Community COVID hubs so many podiatry services were forced to treat patients at home, severely impacting their capacity.

“In addition, we experienced reduced capacity in community and secondary care due to social distancing and infection control and some podiatrists were asked to join COVID-19 services, which meant the footcare team was short-staffed in some areas.”

Anecdotal evidence from MDFTs across England suggest that some diabetes-related foot ulcers were healing well, possibly because people were staying at home and therefore offloading their foot ulcers more than they may otherwise have done.

NHS England also stated that amputation rates have not risen dramatically recently. It has been suggested that there has been an increased burden of avoidable severe foot pathology which may eventually increase amputation levels.

Professor Leigh added: “We’re calling on footcare teams across England to submit their data as we would like to see whether the pattern of increased foot complaints was the same throughout the rest of the country when the pandemic first struck.”

In December, the EDFN issued a clinical strategy for footcare service management during the second  COVID-19 wave. At the moment, the network advises that MDFTs and FPTs should continue to run their clinics and continue vascular surgery.

It also recommends that anyone with diabetes should be made aware that these services are running and if any foot problems develop they should seek help from a specialist footcare team as soon as possible.

To take part in the EDFN audit, click here.


Photo by jose aljovin on Unsplash

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