What are the current diabetic foot assessment methods in private podiatry practices in Belgium: A mixed methods study.

Abstract

Abstract Background Diabetic foot (DF) assessments detect patients’ risk of developing a diabetic foot ulcer and can significantly reduce the risk of amputation. In order to organize this assessment effectively, DF assessment guidelines are required according to the International Working Group of the Diabetic Foot. However, these international guidelines have not been adapted into a national guidelines for podiatrists in Flanders, Belgium. This study aims to explore podiatrists’ views and to identify which methods and guidelines are used to assess the DF in private podiatry practices in Belgium. Methods This mixed methods study was composed of an anonymous online survey comprising of open- and closed-ended questions followed by 1:1 semi-structured interviews. Participants were recruited via e-mail and a closed private Facebook group of podiatry alumni. Data was analyzed using SPSS statistics and thematic analysis described by Braun and Clarke. Results This study showed that the vascular assessment of the diabetic foot exists solely of a medical history and palpation of the pedal pulses. Non-invasive tests such as Doppler or ABPI are seldom used. Only 66% reported to use a guideline for the DF assessment. There was a variety of reported guidelines and risk stratification systems in use. This study raised the podiatrists’ concern of inconsistencies in the interpretation of the risk stratification of the DF between podiatrists. Other reported difficulties in assessing the diabetic foot were the lack of referral pathways and the current DF risk stratification system and reimbursement by the NIDHI in Belgium. Conclusion There is a need to develop a national uniform guideline for the DF assessment in Flanders, Belgium. Further research should focus on implementing and improving the adherence to this guideline to improve the diabetic foot care.