EWMA Podcast: Understanding the Diabetic Foot

GUEST: David G. Armstrong is Professor of Clinical Surgery and Director of the Southwestern Academic Limb Salvage Alliance (SALSA) at the Keck School of Medicine of the University of Southern California. Armstrong has produced 500 peer-reviewed reserach papers in dozens of medical journals as well as over 90 book chapters. 

HOST: Julie Jordan O'Brien is a former EWMA Council Member. She is an advanced nurse practitioner in plastic surgery at Beaumont Hospital in Ireland. 


Important notes from episode 01 - Understanding Diabetic Foot:

a) Preventing diabetic foot ulcers

‘Knock Your Socks Off’ implies that people with diabetes should be encouraged to take their socks off and have their feet examined when they visit a doctor or nurse. A foot examination can be done in just 3 minutes, and it can help detect major risks at an early stage. 
Read more: How to do a 3-minutes diabetic foot exam (Miller et al, 2014).

A multidisciplinary approach to managing diabetic foot is critically important. In this way, patients can more easily navigate the system and get better care in one place.

The ‘toe and flow’ model entails close collaboration between podiatric and vascular surgery. Many studies have shown that this minimises the number of amputations, reduces the lengths of hospital stays and helps avoid re-admissions (Lee & Bevilacqua, 2010).

Moreover, Armstrong refers to the EWMA 2019 conference session ‘Toe and Flow in the Know: Meet the Professors’. The speakers at the session were Armstrong and Joseph Mills.


b) Multidisciplinary approach to diabetic foot management

Armstrong illustrated the multidisciplinary approach to diabetic foot management used at USC’s Keck School of Medicine, where patients meet with five different clinicians (a podiatric surgeon, vascular surgeon, physiotherapist, nutritionist and dietician) during their appointments. The collaboration between podiatric and vascular surgery and physiotherapy has been dubbed ‘Toe, Flow and Go’. Armstrong’s group, SALSA, coined this term. 


c) Technology & Patient Empowement

Armstrong is talking about the role of technology in improving patient adherence and empowering them to take control of their feet. He also refers to the EWMA 2019 conference session that he chaired, ‘Diabetic Foot Ulcers and Rehabilitation Following Amputation’. In that session, he spoke about technological advances in wound management.


d) DF Patient - Quality of Life

Diabetic foot patients have a high risk for psychological distress, and their condition has a big impact on their quality of life. Armstrong mentions Loretta Vileikyte’s research related to the psychological aspects of diabetic foot. You can have a look at some of Dr. Vileikyte’s publications in the references.


e) Person-centred care

Jordan O’Brien refers to the theme of the EWMA 2019 Conference, ‘Person-centred Wound Care. Who is in Charge of the Wound?’ She and Armstrong emphasise the importance of person-centred care when managing diabetic foot.


  • Miller JD, Carter E, Shih J, Giovinco NA, Boulton AJ, Mills JL, Armstrong DG. (2014). How to do a 3-minute diabetic foot exam. J Fam Pract. 63(11), 646–56.
  • Rogers LC, Bevilacqua NJ. (2010). Organized programs to prevent lower-extremity amputations. Journal of the American Podiatric Medical Association. 100(2), 101–4.
  • Vileikyte L, Crews RT, Reeves ND. (2017). Psychological and biomechanical aspects of patient to diabetic neuropathy and foot ulceration. Curr Diab Rep. 17(11), 109.
  • Vileikyte L, Gonzalez JS, Leventhal H, Peyrot M, Rubin RR, Garrow A, Ulbrecht JS, Cavanagh P, Boulton AJM. (2006). Patient interpretation of neuropathy questionnaire. Diabetes Care. 29(11), 2617–24.
  • Vileikyte L, Leventhal H, Gonzalez JS, Peyrot M, Rubin RR, Ulbrecht JS, Garrow A, Cavanagh P, Boulton AJM. (2005). Diabetic peripheral neuropathy and depressive symptoms. Diabetes Care. 28(10), 2378–83.