Problems In The Podiatrist Department With Diabetic Foot Ulcers Assignment

Introduction Of Problems In The Podiatrist Department With Diabetic Foot Ulcers Assignment

The aim of this assessment is to carry out a systematic review of the existing literature to shed light on the challenges being faced by Podiatrists with Diabetic foot ulcer disease. Diabetic foot ulcer or DFU is one of the common complications related to the onset of diabetes. And this complication needs multi-disciplinary care approach, where the individual suffering from DFU should be considered as the adherent of the care team. In this scenario, it is important to mention that, despite advancement in the last 20 years in the treatment process and approach of Diabetic foot ulcers, till now this considers as one of the major health care burdens. One of the major reasons is the patient is already suffering from diabetes and in such a scenario, it seems to be difficult to treat the DFUs because such individuals usually have impaired microvascular circulation disorders which limit the access of phagocytic cells to infected areas and cause poor concentration of antibiotics to the infected tissues (Maher et al., 2019). Additionally, Diabetic foot Ulcers can cause major amputation by 14 per cent to 24 per cent among the patients. According to the report published in NCBI, the mortality rate from this disorder is also very high in the last five years, worldwide which has reached 50-68% among patients who went through lower limb amputation (Jhaveri et al., 2022). This is one of the major challenges that Podiatrists used to face while treating Diabetes Foot Ulcers. This assessment will include an in-depth background of the subject matter.

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Research Aim:

Therefore, the purpose of this research is to highlight the main challenges that Podiatrists used to face while treating Diabetes Foot Ulcer disease. Another important purpose of this assessment is to carry out a thematic analysis of the existing literature with which highlights can be given on the evaluation of the challenges being faced by the Podiatrists department to treat DFUs.

Research Objectives:

Therefore, the objectives of this assessment are:

• To evaluate the term “Diabetes Foot Ulcer”
• The approach related to the treatment of DFUs.
• The challenges being faced by the Podiatrists to treat the DFUs

Background

Research background

Diabetes Mellitus or DM is one of the serious, long-term disorders with a major impact on the well-being of individuals, and societies, across the world. According to the estimation, this disorder is the consequence of more than four million death per year, worldwide and it is estimated that this number might rise to 10.8% by 2030 (Rogers et al., 2020). If this disease is left untreated then it can relapse, or can cause side effects and in serious complications, it can cause ulcers.

The improper management of DFUs or Diabetes Foot Ulcer can lead to relevant problems like reducing the quality of livelihoods, an increase in the disease, and economic burdens on society. The estimated global cost to treat the Diabetes Foot Ulcer disease in 2017-18 was an average of $1.5 trillion and it was reported that in the US, one-third of the health expenditure cost is related to the treatment of Diabetes complications in lower-limb-related issues (Kim, 2019). Similarly, in the UK, the health expenditure associated with the treatment of DFUs was 1 billion euros or $1.36 billion during the financial year of 2017-18 (McMorrow et al., 2022). Many research articles shed light on the geographic differences as the cause of the challenge being faced by the podiatric department in the clinic to treat this complication. More specifically, the lack of emphasis placed on DFUs or the lack of basic training or continuing education in nursing and healthcare departments regarding the treatment of DFUs among doctors and nurses can be considered a major challenge. many research papers articulate the need of accepting or adopting community-driven clinical practice, a standard component of care, and standard pathways for general practice and specialized care by specialist groups.

These principles have also been published by the International Work Group on Diabetes Foot Ulcer Disease and the National Institute for Health and Care excellence. Though, the majority of the articles showcase the lack of adherence to the standard and practices to treat the DFUs. Additionally, surveys of many Podiatrists departments, a lack of evidence-based, and community drive practice approaches can be evident, which underpin the treatment of this disease or complication is still now influence my opinion to a considerable extent. Additionally, in real-time, the data and statistical information about the incidence rate of community-driven Diabetes Foot ulcers are very limited. In the US, during the financial year of 2019-20, the approximate incidence rate of Diabetes Foot Ulcer complications among people who are suffering from advanced-stage of Diabetes was 5.9% to 6.1%, whereas, in Europe, this rate was 2.3% to 2.4% (Jhaveri et al., 2022). Lack of data regarding whether the incidence rate is changing or not, and it seems to be difficult to predict the disease burden on the healthcare setup and the measure that should be taken to treat the complications.

In the UK, as per the report published by NICE.org.uk and the National Health Service (NHS), in 2014/15. 169,000 patients were admitted to hospital with onset of DFUs. The Annual NHS cost related with managing the DFUs is approximately £524 million to £ 729 million (Guest et al., 2018). NICE has also published some guideline to manage and prevent this disorder. For example, care should be provided within 24 hours to the patients by NHS who is suffering with and diagnosed with DFUs or diabetic foot ulcers. Additionally, as per this guideline, the commissioners and every healthcare providers of the NHS should provide foot protection services, so that the disease burden rate related to DFUs can be minimized (Mishra et al., 2017). NICE has also implemented multidisciplinary foot care services to manage diabetic foot problems and treat and manage diabetic foot problems within the community.

Apart from above mentioned economic and social restrictions, there are several other risk factors related to the treatment of DFUs, which put the Podiatrists department into dilemma or challenges to treating this complication. According to the World Health Organisation, and the International Diabetes Federation, DFUs can cause multiple of reasons or factors, the main risk factors related to this complication should be addressed properly to reduce the incidence rate of this disease along with the amputation percentage. Neuropathy comes off as the important cause of the onset of this ulcer. Long-term hyperglycemia can cause damage to peripheral nerve fibres and cause symmetric, and length-dependent multiple neuropathies (Saboo. and Sheohare, 2022).

Additionally, the DFUs are associated with multiple other risk factors like insufficient blood supply, hypercoagulation in lower extremities, serious limb ischemia, and so on. Malnutrition, decreased skin temperature, hyperpigmentation, absence of limb artery pulsation, and muscle atrophy are other risk factors related to this complication (Sutherland et al., 2020).). Therefore, the management of multiple risk factors or symptoms and treatment of DFUs sometimes cause a challenging scenario in clinical practice setup in Podiatrists Department, which in turn can cause a dilemma in the treatment process. This can also be considered as one of the major challenges that the respective department might face when it comes to treating DFUs.

The rationale of the research

The majority of the research articles which are being written on the topic DFUs are used to focus on the complication related to the disorder and the process of treatment. A few research articles are available which are being written on challenges being faced by the expertise to treat the DFUs. As discussed earlier, diabetes foot ulcer is one of the leading causes of mortality and morbidity among patients who are already being suffered with Diabetes or Diabetes mellitus. DFUs are associated with multiple other risk factors like ischemia, neuropathy, absence of nerve impulses in limbs, and so on. therefore, the assessment of existing literature thematically and the development of a comprehensive conclusion on the major challenges being faced by the Podiatrists department to treat Diabetes Foot Ulcers can provide wide scope in the future treatment process. Another significance of this subject matter is, this research can provide highlight the risk factors which can restrict the treatment process for diabetes foot ulcers for patients suffering from diabetes.

Methods

The purpose of this research is to evaluate the problems of Podiatrist’s departments while treating Diabetes Foot Ulcers. To meet this aim and objectives of the work, the secondary research method must be preferable use. More specifically, to evaluate the problems that the concerned department used to face while treating DFUs, a thematic analysis of the existing literature would be carried out. More specifically, for this proposed work, focus will be given to the systematic literature review as the research method. The benefit or justification of using a systematic literature review for this proposed work is to identify, select and critically appraise research papers to answer the setup objectives ().

Research Approach

The purpose of this proposed study is to identify the major challenges being faced by the Podiatrists Department while treating DFUs. Additionally, by considering the research questions, it can be realized that an inductive research approach will be preferable. inductive approach or inductive reasoning is used to start with observation and theories are proposed at the end of the research process as a result of the observation (Mukherjee, 2019). The justification for choosing an inductive research approach for this proposed study is, here thematic analysis will be carried out to address the challenges the Podiatrist department used to face while dealing with or treating Diabetic Foot Ulcers or DFUs. Therefore, observation or in-depth assessment of existing literature can be used as an effective way to observe the reasons related to the challenges being faced by the Podiatrist Department to treat Diabetic Foot Ulcers. Another justification behind choosing the inductive approach for this study is that it can help the researcher to develop an explanation or theory regarding the challenges being faced by podiatrists to treat foot ulcers. More specifically, with an inductive research approach, it will be easy to generate meaning from the data set collected via secondary research and identify the pattern and relationship between the variables to build the theory. Patterns, resemblances, and continuity are being observed through an inductive research approach which in turn can help to conclusions (Pandey and Pandey, 2021). In reference to the proposed subject matter, it can be stated that with an inductive research approach, the researcher can identify the pattern of the data set in terms of the factors or the extent to which the Podiatrist used to face challenges with DFUs. This observation, and the pattern of the data set and resemblance between the information being published in existing literature can help to develop a comprehensive conclusion by developing theories on the factors that are related to the challenging scenario and the extent to which podiatrists used to face dilemma to treat the DFUs.

Research Design

Considering the research topic and objectives of the study, an exploratory research design will be suitable to choose. Exploratory research as the name suggested, it intends to explore the research questions but does not provide a conclusive solution to the existing problem (Newman and Gough, 2020). Another important fact of exploratory research design is, this type of research is usually carried out for studying the problem matter which has not been clearly defined. A thorough analysis of online resources, it can be seen that there are very few research articles that are based on medication and treatment of DFUs or Diabetic Foot Ulcers, but a few articles are based on the challenges being faced by the Podiatrist department to deal with this complication. Therefore, exploratory research design will give an opportunity for the researcher to thoroughly assess the existing literature or journals and articles to derive the predictive reasons or factors related to the dilemma in dealing with the DFUs by the Podiatrist Department. Additionally, the entire study will be based on the secondary research method or more specifically the thematic analysis of the literature review (Cates et al., 2019). Therefore, choosing the exploratory research design is ideal as it is based on the observation method and helps the researcher to tackle new problems on which little or no such prior research has been done.

Research method

Considering the research objectives, the qualitative research method has been used for this study. More precisely, the thematic analysis has been carried out for this proposed systematic literature review. To conduct thematic analysis, relevant research articles and journals will be selected from online sources and will be reviewed by focusing on the research objectives and questions (Newman and Gough, 2020).

Data Analysis method:

As the method of analysing the information collected from online sources, the narrative analysis will be followed. The benefit of using thematic analysis is to understand how the existing literature or articles have constructed narration regarding the DFUs, the challenges related to the treatment of these complications and what are the dilemmas being faced by physicians to deal with these disorders. In this study, some themes will be represented based on the set-up objectives, and existing literature will be assessed in-depth based on the theme and set-up questions. These, in turn, can help the researcher to develop a comprehensive theory or idea about the proposed subject matter.

For the systematic literature review, search strategy has been used as the tool for selecting information, research articles, and journals from online sources.

Search Strategy is an organised structure of key terms used for searching the database.

Keyword Search:

Objective 1: keywords: Diabetic Foot Ulcers

Objective 2: Keywords: Treatment, Challenges, UK

Objective 3: Podiatrist, DFUs, Challenges

Inclusion and Exclusion Criteria:

• Inclusion Criteria:
• The research articles, journals and research papers include information about Diabtetic Foot Ulcers
• The research articles, journals and review, include information about treatment and guideline followed in the UK and other countries related with DFUs
• The aticles, journals and reviews that include information about major challenges that podiatrists used to face while treating and managing DFUs
• Exclusion Criteria:
• The research papers, journals which do not include information about DFUs
• The articles and journals which do not include information about treatment management process and challenges that podiatrists face with DFUs
• The articles and journals that published on of before 2012

Ethical consideration

When it comes to carrying out any research, ethical considerations should be kept in consideration. This proposed study is based on the secondary research method, therefore, ethical consideration will be set up in such a way, so that every piece of literature or article which will be used for the thematic analysis should be acknowledged properly. Additionally, as per the University policy and Data protection Act, 2010, it should also be ensured that the data and information collected from online sources have been used for academic purposes and that the whole work is free from plagiarism. The importance of following ethical considerations are:

• It ensures the validation of the used information.
• Avoidance of error can be managed.
• Prohibition against data fabrication, or falsification can be carried out.

Results

Theme 1: Managing co-morbidity related with DFUs by Podiatrists

According to the article Cates et al., (2020), diabetic Foot Ulcer disease is one of the major causes of type 2 diabetes or Diabetes Mellitus. This article mentioned that DFUs is one of the common cause of hospitalization of diabetic patients and result frequently result in the amputation of lower limbs. According to the data mentioned in this article, one million people used to undergo non-traumatic leg amputation annually, across the globe, and 79% of the people who have T2DM or type 2 diabetes mellitus used to get vulnerable to the onset of this complication. The risk of death is also increased by twice a time for people with diabetes mellitus and DFUs, in comparison to the patients without DFU. The amputation rate in the patient with DFUs is 39 per cent and infection is a common complication by more than 50 per cent for this disorder. This article also show-cases in the data that 85 per cent of the limb amputation in diabetic patients used to cause the onset of DFU and made it a chronic infection. In relation to the Podiatrist department, Diabetic and Diabetic Foot Ulcers, Maher et al., (2019) has mentioned that DFUs used caused due to mechanical changes in the foot, peripheral arterial dysfunction, and peripheral neuropathy. This article also sheds light on the role of podiatrists to treat DFUs. According to this article, Podiatrist used to play an important role in the multidisciplinary team to treat diabetic foot ulcer disease or diabetic limb salvage. Podiatry can be defined as the specialist who is licensed to diagnose and treat the pathologies associated with the ankle and foot and their treatment process includes surgical modalities as well as conservative modalities. Preventive ulcer development is a strategy to treat diabetic foot ulcer complications, which is also employed by the podiatrist. Additionally, according to the article written by Macdonald et al., (2019), another important role or relationship between podiatrists, and DFUs, according to this article, is associated with the regular monitoring of the disease, routine care of the calluses, and providing recommendations to the patients. Finally, a continuous management process employed by the Podiatrist can help the patient to get rid of the ulcer recurrence.

Theme 2: Challenges related to the Diabetic Foot Ulcer- as podiatry-led tertiary service

According to the article Blanchette et al., (2020), diabetic foot ulcers, or DFUs consider as the leading cause of non-traumatic lower limb amputation and it is associated with lifetime risk by 29 per cent of the pathway to DFU development. According to this article, DFU development is related to several risk factors like DPN or diabetic peripheral neuropathy, PAD or peripheral arterial disease, prior DFU and amputation, and ESRD or end-stage renal disease. This article has mainly highlighted upon the outcome of DFUs. For example, PAD with DFUs can reduce the healing rate among the patient by 52 per cent to a patient without PAD. On the other hand, DFUs can cause the onset of DFI or diabetic foot infection as well as osteomyelitis by 20%. In this article, the focus has also been given to the categorization of the DFUs and the tertiary services being offered by the podiatrist department. As per the article, in current podiatry-led tertiary service, the incidence rate of the DFUs, outcome, and days have taken to heal the DFUs are usually considered as the benchmark of the treatment process (Banu et al., 2021). In the article written by Ong et al., (2022), the focus has been given to the experiences received by the podiatry care to treat the DFUs. In this article, nine systematic review papers were identified from five countries with varying DFU prevalence rates. According to this article, treatment and managing the DFUs need multi-faceted approaches which involve podiatrist and healthcare professional, and the individual with DFUs. According to this article, sometimes, lack of information from other healthcare professionals about the comorbidity of the patient with DFUs, lack of multi-disciplinary approach can put podiatrists into challenging scenario to provide treatment to the patient.

Considering this article and the nine reviewed journals, it can be seen that there are multiple of variables associated with the outcome and days of healing DFUs. In this article patients’ age, gender, HbA1c, BMI, type and duration of diabetes, vascular intervention, smoking status, pre-existing disease, and comorbidities are the major factors which associated with the treatment and healing of DFUs and amputation. Though, in this article, another important focus has not been given to the exact challenges that podiatrists used to face while dealing with DFUs.

Theme 3: Challenges that Podiatrist face with Protein signaling diabetic Foot Ulcer

According to the article by Alhubail et al., (2020), obesity, and medical comorbidities are the major challenging scenarios that Podiatrists used to experience while treating DFUs. According to this article, managing the comorbidities or identifying the comorbidities for a patient with diabetes is a time-consuming matter. On the other hand, laboratory parameters like measuring the glucose level, creatinine, complete blood count, albumin, erythrocyte, sedimentation rate, and C-reactive protein are time-consuming which increases the identification and treatment time for DFUs (Lebig., 2021).

On the other hand, increased duration to the identification of comorbidities and setting up treatment plans for patients with DFUs, increase the challenges for podiatrists to set up early intervention plans. Additionally, in this article, light has been given to collaborative working between podiatrists and primary care physicians or endocrinologists to cure diabetes or any other comorbidities for the patient before the treatment of DFUs (Sutherland et al., 2020). In such a scenario, a lack of communication and retrospective data and information about the patient's recovery rate or conditions can put the Podiatrist department into a dilemma to set up and implement an early intervention plan for treatment.

Discussion

Diabetic Foot Ulcers or DFUs are now considered as one of the most common and serious complications related to Diabetes. And this complication needs prompt and proper treatment, and preventive measures to restrict the onset of further complications like infection amputation. In this research assessment, several existing articles and literature reviews are being assessed thoroughly. An in-depth analysis of these articles shows that several challenges can be encountered by Podiatrists when it comes to managing Diabetic Foot Ulcers. Considering the information being allocated from the thematic analysis of the existing literature and articles, it can be stated that,

• Poor glycaemic control is one the major challenges that podiatrists used to face while dealing with the DFUs. Diabetic Foot Ulcers are associated with or can be considered one of the major complications related to the onset of T2DM (McMorrow et al., 2022). For a patient with an advanced stage of Diabetes mellitus, elevated blood glucose level can delay the wound healing process and increase the risk of infection (Maher et al., 2019).
• Considering the analysis of other articles into consideration it can be stated that vascular compromise, like poor blood flow, can also impede healing and increase the risk of infection (Sutherland et al., 2020). Sometimes, the onset of vascular dysfunctioning can put the podiatrist into a challenging scenario to assess the sign of vascular compromise and increase the time of healing or recovery from DFUs, as in this situation, the patient has to be referred to vascular specialists (Sutherland et al., 2020).
• Moreover, an in-depth analysis of many articles also shed light on the fact that lack of patient compliance, and difficulties of the patient adhering to the complex treatment process including offloading and glucose monitoring can put podiatrists into the challenge of providing an early recovery plan or intervention plan to the patient (Banu et al., 2021). Here the Podiatrists need to educate the patient and motivate them to follow the prescribed treatment plan.

Conclusion

To conclude this assessment, it can be stated that in this systematic literature review, the focus has precisely been given to identifying the challenges being faced by Podiatrists to deal with diabetic Foot Ulcers. The secondary qualitative research method has been selected to allocate information and derive a comprehensive conclusion on the subject matter. considering the analysis of research articles, and systematic review of the journals, it can be highlighted that diabetic foot ulcer needs a comprehensive, and multidisciplinary approach for the podiatrist department to manage serious complications. And Podiatrists used to play the most important role to prevent, treat and manage this complication which is closely related to diabetes mellitus. Though, there are several challenges delayed time in identifying the comorbidities within the patients, referral of the patients to another specialist to suppress the comorbidities, lack of retrospective data from primary physicians regarding the patient's amputation percentage, and lack of education between the podiatrist and patient to adopt the complex treatment approaches are being referred in this study as major challenges faced by the Podiatrist department while dealing with DFUs.

Though, the major limitation of this study is the lack of retrospective data and information that has restricted the researcher to develop an in-depth conclusion about the major challenges being faced by Podiatrists when it comes to dealing with DFUs. Additionally, in this article, the lack of quantitative data, and the survey of the podiatrist also limits the information with which the major challenging situations related to the treatment of DFUs can be established.

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