Podiatric surgery and the diabetic foot: a retrospective cohort study of community based diabetic foot surgery

Diabetic foot multidisciplinary teams (MDT) have been shown to improve incidence and risk reduction in foot ulceration and decrease major lower-limb amputation. This Podiatric surgery team is part of a community-based foundation trust offering day-case foot surgery under a local anaesthetic. It has recently been integrated into an established diabetic foot MDT. Aims: To compare the outcomes from two cohorts who received diabetic foot surgery for the treatment or prevention of diabetic foot ulceration and/or infection before and after integration into an established diabetic foot MDT. Methods: A retrospective cohort study comparing outcomes between April 2014–November 2016, and January 2022–August 2023. A Microsoft Excel database was used to record the outcomes of interest, which included the number of referrals, demographics, surgical procedures, ulcer healing rates, complications, and whether the patient was subsequently discharged from the diabetic foot MDT clinic. Results: There was a 72% increase in referrals received in 2022/23 (179) compared to 2014/16 (104). A total of 253 procedures were performed compared to 74 in 2014/16. 92% of wounds healed in 2022/23, compared to 85.9% in 2014/16. 83% were discharged from the MDT compared to 70% in 2014/16. 73.4% of admissions resulted in healing without complication, compared to 67.5% in 2014/16 and the minor amputation rate halved over the 6-year period. Conclusion: The integration of a podiatric surgery team into an established diabetic foot MDT has improved surgical outcomes and increased the number of patients discharged from the MDT.