Foot problems related to diabetes are common, and sensation and the blood supply to the feet can be impaired, which if not detected early enough can predispose a patient to ulceration and in some cases amputation. There are over 7000 diabetes related amputations annually in England, and many of these are preventable. Early detection of foot problems in patients with diabetes is vital in preventing these, including an annual foot check and ongoing monitoring and management by a podiatrist and the wider medical team as required. One of the most important issues however, is an individual’s awareness of their own condition and how it affects their feet.
Over the past year, I have been fortunate to be involved in a project with our professional body, the College of Podiatry and Foot in Diabetes UK as well as other professional groups including the Royal College of Physicians and Surgeons of Glasgow, the British Association of Prosthetists and Orthotists on the development of a smartphone and tablet app for patients with diabetes on maintaining their foot health. The app is also recognised by the Royal College of Nursing and Diabetes UK.
I would encourage all of our patients with diabetes (or family members) to download the free app to their devices, as it provides straightforward, practical advice on looking after your feet, and how to recognise when things go wrong (and when and how to seek help).
The app is available on Apple iOS and will be available on Android devices soon. For more information, search for diabetic foot screening app on the app store, or visit:
Pics 1 and 2 (below): The app includes videos on what to expect at your annual foot assessment and
allows you to save your appointments to your calendar and it notifies you beforehand. It also allows you to store important numbers including your GP, podiatrist and hospital foot clinic.
Rwanda is a small ambitious country known as the land of 1000 hills with a population around 12 million and a rapidly growing economy. It has rolling hills for as far as you can see, a rain forest, gorillas and volcanoes, making for quite the site to any visitor. However, it is also known for the 1994 genocide in which over 1 million people were killed in 100 days across the country.
This tragic event has led to some very big health issues, which the country still faces, but thanks to a range of donor funding and strong political leadership, the country is on its way to quickly becoming a middle-income country.
As countries shift from low incomes to middle income economies, health issues become complex, where the country can face a mix of communicable disease (ie. malaria, HIV, TB) and the introduction of non-communicable disease (ie. diabetes, high BP, cholesterol) with changes in lifestyles.
Now you are probably wondering what this has to do with podiatry?
Well, as clinicians we play a role in the overall wellbeing of every patient that walks through our door for treatment and we become advocates for a number public health issues. While our specialist area is focused on the foot and ankle, an understanding of the bodily systems is imperative for understanding the impacts on the lower limb. This allows us to transition from clinical practice to other work streams such as health policy, public health programmes, service management and research.
As a podiatrist with a public health background, the increase of diabetes and chronic conditions in developing nations has become of personal interest. In many of these countries, diabetes is poorly understood and without proper prevention and care, can lead to a large economic burdens on the healthcare system. In 2012, the UK alone spent a whopping £639 million on foot ulcers and £662 on lower limb amputations, so the prevention and monitoring of these conditions is of paramount importance in the developing world.
The quality of life for individuals with diabetes is also drastically affected if not controlled, impacting mobility, footwear and overall lifestyle. Additionally, chronic ulceration and limb amputation, creates an increases risk (approximately 80%) of mortality within the first 5 years post amputation.
How did all this lead me to Africa, I hear you say?
In April of 2016, I (sadly) departed from the Betafeet clinic to implement an mhealth project in Rwanda in partnership with the Ministry of Health. This project, allows patients across the country to speak with a doctor and receive a prescription via SMS through their mobile phone, reducing the travel time, wait time and expense of receiving care from one of the local physical hospitals. The system is also working on monitoring both communicable and non-communicable disease using artificial intelligence, engaging patients to take ownership of their health.
This could be a major milestone for a country with stretched resources. To put things into perspective, over 80% of the population lives in remote areas of the country and works in the ‘in-formal’ sector as subsistence farmers with an average income of 2-3 dollars per day, which is not very much. To receive care, a patient may travel over an hour to reach their nearest hospital where a doctor is present and then wait anywhere from a few hours to a few days to receive the care they need. However almost 80% of the population already has a mobile phone.
Appropriate access to clinical care is a large part of the prevention and management of many conditions and undertaking this project has been a great experience. As a clinician, I have had the opportunity to utilise my knowledge to develop operational pathways and input into the technology development to shape the way patients receive their care.
It is with
this experience I now look to move on to my next adventure focusing on Aboriginals
and the utilisation of technology in the prevention of major non communicable
disease such as diabetes.
Final comment from Reggie Simpson and Betafeet Podiatry
We wish Andre the very best in his future and thank him for this interesting blog account. We look forward to his next blog focused on his work with the Aboriginal population.