CME OnDemand: 2022 AOFAS Annual Meeting-The Impact of a Pandemic on the Provision of Diabetic Foot Care. Then, Now and the Future

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The document discusses the impact of the COVID-19 pandemic on the provision of diabetic foot care. Before the pandemic, there were integrated multidisciplinary diabetic foot clinics (DFC) in most regions, and some orthopedic surgeons were embracing preventive and reconstructive diabetic foot surgery. However, when the pandemic hit, everything locked down and face-to-face appointments were drastically reduced. Virtual appointments were instituted, and medical staff were redeployed, leading to a loss of integrated working. All non-life-threatening orthopedic surgery was stopped, including elective surgeries.<br /><br />During this time, community diabetic podiatrists were redeployed to replace district nurses for dressing and wound changes. Patients were taught how to change dressings themselves, aided by family support during the furlough scheme. Acute services remained closed, and waiting times increased. Diabetic foot patients fell through the cracks as they were too chronic for trauma lists but too unfit for elective lists. Vascular surgery saw an increase in sepsis cases due to delayed treatment of ulcers, leading to increased amputation rates.<br /><br />The second wave of the pandemic further reduced capacity for acute services and elective orthopedics, leading to even higher amputation rates. Looking towards the future, returning to normal is unlikely as some changes implemented during the pandemic, such as virtual appointments, may remain. However, there are challenges in accessing GP services and medical services, and the recovery of the diabetic foot service, particularly community services, is predicted to take another 12-24 months due to staff loss, disruptions in education and training, and reduced research opportunities.

Asset Subtitle

Roslyn Miller, MB, ChB, FRCS(Ed), FRCS(Tr&Oth)

Keywords

COVID-19 pandemic

diabetic foot care

virtual appointments

medical staff redeployment

acute services closure

increased amputation rates

delayed treatment of ulcers

elective orthopedics

challenges in accessing GP services

recovery of the diabetic foot service