A few months ago we discussed a paper by Pete Lazzarini and colleagues showing a greater inpatient burden of foot disease in Australian hospitals. A second article has now been published using this massive dataset, to further investigate how many inpatients have foot disease present and what factors are they linked with.
This article reports that 10% of all inpatients had foot disease and half of those inpatients were in hospital because of their foot disease. Additionally, within inpatients with diabetes, it found that 1 in 5 inpatients had foot disease, and nearly half of those were in hospital because of their foot disease. Perhaps the most important finding from this study was that the factors related to foot disease, when adjusted for diabetes, are the same as the well-known factors for diabetic foot disease.
Apart from smoking, none of the independent factors were modifiable, but it is striking that peripheral neuropathy, peripheral arterial disease, previous foot ulcers and trauma were found to be related to foot disease, even when controlled for diabetes. This strengthens ideas about the existence of ‘foot disease’ in people without diabetes, when they present with the well-known risk factors that we already know determine diabetic foot disease.
For daily clinical practice, this implies that all patients presenting with peripheral neuropathy, peripheral arterial disease or a previous foot ulcer should receive preventative treatment. Most of this preventative treatment in Australia now seems focussed only on patients with diabetes. However, the researchers found foot ulcers in 23 inpatients without diabetes, vs 26 with diabetes. If we focus on people with diabetes only in daily clinical practice, we may fail to care for about half of the people who end up in hospital with foot ulcers.
Apart from the independent factors, the study again stressed the silent burden of foot disease in Australian hospitals. Forecasting their findings across all of Australia’s public hospitals, the authors suggest that patients with foot disease fill over 4,800 public hospital beds each night, contributing to a cost of up to A$4.7 billion per year. That is another major reason to focus on prevention of foot disease, in all people with peripheral neuropathy, peripheral artery disease and previous foot ulcers.