Investment in podiatry is urgently needed if diabetic footcare is to survive the “tsunami” caused by the perfect storm of a declining workforce and increasing rates of diabetes, experts have said.
Delegates at the English Diabetes Footcare Network’s national conference heard how rates of major amputations have been steadily increasing, while the number of newly qualified podiatrists has fallen.
Vascular nurse consultant Dr Leanne Atkin and consultant diabetologist Professor Mike Edmonds put the role of the podiatrist in the spotlight during the discussion, ‘The role of podiatry: From the eyes of a Consultant Diabetologist and a Vascular Nurse Consultant’.
Delegates heard how, between 2017 and 2020, there were 7,957 major amputations, and that the rate of amputations is significantly higher in deprived areas.
Despite the challenges, just 126 graduates qualified as podiatrists in England in 2021, and there is now one podiatrist per 5,500 residents in England. In addition, they are not all dedicated to diabetes foot disease due to specialising in other areas such as biomechanics and rheumatology.
All this has led to calls for urgent action and investment in podiatry.
Dr Atkin, from the Mid Yorkshire Hospitals NHS Trust, said: “There’s a tsunami heading towards us and we need podiatry if we are going to survive. This is a workforce crisis, and it is not getting the media attention that nursing gets.
“When you look at the number of podiatrists, it is truly shocking. Podiatrists are essential and are not replaceable, even by the most highly skilled nurses.”
Dr Atkin pointed out how podiatrists made a huge contribution during the pandemic by transferring their skills in wound care to help patients in hospital, and delivering footcare to some of the most severely ill COVID-19 patients in intensive care.
She also highlighted how podiatrists have a role in preventative care, for example by being able to detect atrial fibrillation, the main cause of stroke.
Dr Atkin said making the career pathway in podiatry more attractive could help to increase the workforce, as well as raising awareness of senior roles such as the consultant podiatrist.
She said: “How can the number of people with diabetes be increasing so much but the number of podiatrists be dipping down? Not investing in podiatry is leading to poor outcomes and high costs right now.”
Professor Edmonds, from King’s College Hospital in London, described podiatrists as the “essential gatekeepers” of diabetic footcare.
He said: “The diabetic foot is very complex. It proceeds very quickly, can destroy a foot in 48 hours and if not treated, it can kill the patient. Time is tissue – you need action very urgently and you need the expert help to be readily available. The gatekeeper of all this is the podiatrist.”
Professor Edmonds pointed out that as the number of people with diabetes is rising, so is the number of amputations. Overall, the rate remains static and is not falling.
He said: “There are very disturbing variations in rates of amputations across the country, with the rate of major amputations in the most deprived areas nearly double in comparison to the least deprived areas.
“The podiatrist is essential in the care of diabetic foot. The podiatry workforce should not only be preserved, but actually increased to improve the disappointing outcomes of diabetic foot care in England.”
It comes after Diabetes UK expressed concerns about the major differences in the rates of amputations for people with diabetes.
The discussion at the EDFN conference was chaired by Derek Thomas MP, Chair of the All-Party Parliamentary Group for Diabetes.
It formed part of the network’s national conference on April 29, which gave anyone involved in the care of the lower limb and diabetic foot the opportunity to hear latest research, best practice and case studies. Topics included health inequalities, wound care and mental health services.
