25 August, 2021
A best foot forward approach to podiatry care
The possibility of losing a toe, foot, or leg is a scary thought, but a real fear for 10 per cent of the adult population that develop lower extremity ulcers during their lifetime.
This Wound Awareness Week (23-29 Aug 2021), CQUniversity Podiatry Clinical Supervisor Adriaan Erasmus is shedding light on the work podiatrists do to treat and minimise the impact of common venous leg ulcers and diabetic foot ulcers.
“Chronic wounds aren’t talked about enough, and sometimes it feels like they aren’t talked about at all, but it is a growing problem in Australia. As the incidence of diabetes increases, so does the rate of leg and foot ulcers,” Mr Erasmus said.
“These wounds won’t heal without specialised intervention. This is where podiatrists can step in.”
He explained that podiatrists are considered the gatekeepers of information for patients with foot ulcers and make important decisions surrounding their care and treatment.
“Podiatrists are the healthcare professionals that most frequently follow up with patients and provide wound treatments. These treatments may include wound debridement, dressing recommendations and prescription of appropriate footwear for offloading,” he said.
“Without addressing all these other factors some of these wounds will not be able to heal. We have a saying in wound care – treat the whole patient and not just the hole in the patient.
“A podiatrist needs to be constantly aware of all the patient's comorbidities and make relevant referrals to other specialists such as Vascular surgeons, Endocrinologists, Infectious Disease specialists and Diabetes Educators, to assist and optimize the patient’s general health. Due to the complexity of some chronic wounds, Mr Erasmus was required to spend time with patients and get to know them on a personal level, sharing with them the highs and lows of the process.
“A patient that made a lasting impression on me was a 40-year-old diabetic schoolteacher that loved his job. He had a very bad foot ulcer that was complicated by Charcot’s neuroarthropathy. To make his wound healing more challenging he also presented with venous incompetence that resulted in lower limb swelling and affecting wound healing,” he said.
“Unfortunately, over time his condition deteriorated due to major joint destruction associated with Charcot’s that was not within our control. This started to affect his work and mental health.
“We reached a stage where we would not be able to save the limb and the patient underwent a below-knee amputation. He fully recovered and was fitted with a prosthesis to return to work and function almost as normal. It was amazing to see the transformation in the patient’s wellbeing afterwards!” While he said a podiatrist’s focus is to save limbs and prevent amputations, this is not always possible and, in some cases, can be the best option for a patient to improve their quality of life.
“I assisted this patient in making his decision in a timely fashion while he was still in good health to tolerate and recover well from the surgery. This also provided him with the best possible rehabilitation potential.
“This highlights how important it is to manage the patient and not just focus on the wound. Our aim is to give patients their dignity back and improve their quality of life.”
As a wound healing and tissue repair specialist, Mr Erasmus has been exposed to many of the advanced and newer wound care technologies and is passionate about exploring new podiatry techniques.
“During my career, I was fortunate to use Negative Pressure Wound Therapy (NPWT) daily and can appreciate its role in wound management. It was introduced in the early 1990s and today it is a vital treatment modality for complex surgical wounds.
“One of the most interesting wound treatment modalities I was fortunate to use must be Maggot Debridement Therapy. It is always something that will stimulate some discussion. It is a modality that certainly can play a role in the management of ischemic wounds; however, it does have its limitations and is not for everyone.
“Unfortunately, many new technologies have limitations in daily clinical practice and never get fully utilised but hopefully, over time, some new technologies will find their way into daily practice to the benefit of more patients.”