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Published on: March 3, 2023
Saving the Diabetic Foot During the COVID-19 Pandemic: A Tale of Two Cities
Laura Shin1, Frank L Bowling2, David G Armstrong1
1Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Insights
The COVID-19 pandemic shifted diabetic foot ulcer care from in-person visits to telemedicine. This review explores virtual consultations and home care models, suggesting new possibilities for managing diabetic foot complications.
Area of Science:
- Podiatry
- Diabetology
- Telemedicine
Background:
- Diabetic foot ulcers traditionally require frequent in-person clinic visits for wound care.
- The COVID-19 pandemic disrupted standard outpatient consultations and diagnostic procedures.
Purpose of the Study:
- To describe innovative care delivery models for diabetic foot ulcers during the COVID-19 pandemic.
- To evaluate the feasibility of telemedicine and home-based care for diabetic foot complications.
Main Methods:
- Review of approaches in two centers specializing in diabetic foot disease.
- Utilization of virtual consultations (physician-to-patient, physician-to-home nurse) and home podiatry visits.
- Illustration of methods with case vignettes.
Main Results:
- The pandemic necessitated a paradigm shift in diabetic foot ulcer management.
- Telemedicine and home-based care strategies were implemented to maintain patient access to treatment.
- Case examples demonstrated the application of these alternative care models.
Conclusions:
- The described approaches offer potential new models for delivering care to patients with diabetic foot ulcers.
- Telemedicine and home care may represent viable alternatives for managing diabetic foot complications, especially during public health crises.
Abstract:
Of all the late complications of diabetes, those involving the foot have traditionally required more face-to-face patient visits to clinics to treat wounds by debridement, offloading, and many other treatment modalities. The advent of the coronavirus disease 2019 (COVID-19) pandemic has resulted not only in the closing of most outpatient clinics for face-to-face consultations but also in the inability to perform most laboratory and imaging investigations. This has resulted in a paradigm shift in the delivery of care for those with diabetic foot ulcers. The approaches to this challenge in two centers with an interest in diabetic foot disease, including virtual consultations using physician-to-patient and physician-to-home nurse telemedicine as well as home podiatry visits, are described in this review and are illustrated by several case vignettes. The outcomes from these two centers suggest that we may be witnessing new possibilities in models of care for the diabetic foot.
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