Reducing diabetic foot complication through a multidisciplinary chiropodist-based intervention: A Randomized Clinical Trial

Recently, Diabetes Canada published some staggering statistics on the rate of amputation for those with diabetic foot ulcers, a major and feared complication of diabetes. Ontario reported one of the worst outcomes among the provinces in Canada, with an estimated lower-limb amputation rate of one every four hours. While rates of myocardial infractions and strokes in persons with diabetes has decreased in Ontario over the past decade, the prevalence of diabetic foot ulcers leading to lower limb amputations has increased in Ontario over the same time period. The human and financial toll of this condition is exceptional. According to the International Diabetes Federation, persons with diabetes are 15 to 40 times more likely to require lower limb amputation compared to the general population. Approximately 85% of amputations are preceded by the development of a neuropathic foot ulcer with a life time risk for foot ulceration in people with diabetes being 15-25%. Following amputation, the 5 year mortality rate is 50% (ref)

Recently, our Foot Care and Prevention of Amputations Research Program this team was successful in securing funding for their chiropody-led program to reduce amputations in patients with diabetes and chronic renal failure from the CIHR Operating Grant competition for SPOR Innovative Clinical Trials with Diabetes Action Canada as a funding partner. This multi-year grant will take an alternate approach, using the expertise of chiropodists, to manage and prevent this devastating outcome for diabetic foot ulcers. Chiropodists are specialists in foot care and have a scope of practice that includes assessing, diagnosing and treating lower limb and foot disorders. The intervention of chiropodists, when engaged at the right time, has proven to reduce the instances of lower limb amputations related to diabetic foot ulcers. In the proposed multi-centre study (Ontario, Manitoba and Alberta), Drs. Subodh Verma and Mohammed Al-Omran and their team propose a chiropody-led approach that will focus on early treatment of foot ulcers and prevention of relapse for persons with diabetes on dialysis. Individuals with diabetes and kidney failure are among the most vulnerable to developing foot ulcer. This study will measure the impact of this strategy on the quality of life of those affected, the rate of lower-limb amputation and related hospitalization, and hospital readmission. This study, if successful, has the potential to demonstrate a cost effective and patient-oriented treatment plan that will improve how diabetic foot ulcers are managed in in the Canadian health system.

To read more about this award visit here

Graphic to depict study design for the multidisciplinary chiropodist-based intervention: A Randomized Clinical Trial


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