AIMS:We evaluated the cost-effectiveness of implementing a novel funding model to incentivise earlier access of patients with diabetes-related foot disease (DFD) to diabetic foot services (DFS). METHODS:In this multi-centre pre-post study, we compared the cost, quality-adjusted life year (QALY) and clinical outcomes of patients with diabetes-related foot disease who had usual access to ambulatory DFS (controls) to patients who accessed the new DFS (intervention) across 15 regions in Queensland, Australia. A generalised linear model was used to estimate the difference in controls and intervention group outcomes, and a Bayesian Markov model estimated transition probabilities between seven health states over a 5-year time horizon from an Australian health service perspective. RESULTS:Overall, 1687 patients were included (830 control, 857 intervention). Compared to controls, the intervention group had a lower projected probability of hospitalisation, particularly after 20 months. The intervention also had reduced costs (-$8429 [95% confidence intervals: -$8461, -$8397]) and increased QALYs (0.06 [0.05, 0.07]) compared to controls. On average, $AU1 invested in the intervention generated a return of $AU7.86 [$7.63, $8.09]. CONCLUSIONS:We found investing in earlier access to DFS to be cost-effective and generated considerably improved patient outcomes, cost savings, and return on investment.

INTRODUCTION:Infections precede nearly all hospitalizations and amputations related to diabetes-related foot disease. Focusing on antibiotic management, we aimed to report the outcomes of people presenting with a new diabetes-related foot infection (DFI). RESEARCH DESIGN AND METHODS:In this prospective study conducted in Australian and New Zealand hospitals between 2018 and 2020, patients with diabetes, a foot ulcer and a newly diagnosed DFI were eligible for enrollment. DFI was categorized as mild or moderate/severe DFI, with the latter further categorized according to the presence of osteomyelitis. The primary outcome was healing of the index ulcer or amputation site at 6 months. Multivariable logistic regression analyses adjusted for potential confounders were undertaken to investigate the relationship between ulcer healing and infection severity, intravenous antibiotic duration and total antibiotic duration. RESULTS:Of 234 included patients presenting to 20 centers (mean age 61 years, 77% male), 15% had mild DFI, 31% moderate or severe DFI without osteomyelitis, and 54% moderate or severe DFI with osteomyelitis. Methicillin-resistant Staphylococcus aureus was identified in 7% (16/214) and Pseudomonas aeruginosa in 3% (7/214). Median (IQR) days of total antibiotic management were 18 (10, 22) for mild DFI, 20 (11, 40) for moderate or severe DFI without osteomyelitis and 34 (15, 51) for moderate or severe DFI with osteomyelitis. Healing at 6 months was 73% (22/30) in those with mild DFI, 68% (42/62) in moderate or severe infections without osteomyelitis and 62% (69/111) in moderate or severe DFI with osteomyelitis. After adjusting for confounders, none of infection severity, intravenous antibiotic duration or total antibiotic duration were associated with ulcer healing. CONCLUSIONS:Healing at 6 months following DFI does not appear to be associated with infection severity or antibiotic management. To plan clinical trials of antibiotic therapy for DFI, further work is required to define target subgroups and meaningful trial endpoints.

ABSTRACT Introduction Foot‐related conditions are a leading cause of all hospitalisations and amputations worldwide. Half of these foot‐related hospitalisations are in people without diabetes. Yet, few studies seem to have explored risk factors for foot‐related hospitalisations in populations with or without diabetes. This study aimed to systematically review studies investigating risk factors for hospitalisations caused by any foot‐related conditions amongst any general community‐dwelling adult populations (with or without diabetes). Methods PubMed and Embase databases were searched for studies related to risk factors, foot‐related conditions and hospitalisations published since 1st January 2000. Search results were screened for eligibility by two independent authors. Risk of bias was assessed using the Quality in Prognostic Studies tool, and data were extracted using a customised data extraction tool. Results Fourteen studies from 7824 screened studies were included. Twelve studies investigated diabetes populations and two general (with and without diabetes) populations. All 14 studies investigated only for foot disease‐related hospitalisation outcomes. Seven studies were rated as low risk of bias. Twenty‐two independent risk factors were reported, including eight reported both in multiple studies and low risk of bias studies. Those eight risk factors were being male, having diabetes, increased HbA1c, insulin management, chronic kidney disease, peripheral neuropathy, peripheral artery disease and no footcare within 12 months. Conclusions This review suggests that the common risk factors for foot disease‐related hospitalisations are being male, having diabetes, chronic kidney disease, peripheral neuropathy, peripheral artery disease and lack of footcare, particularly in diabetes populations. There were no studies investigating hospitalisations for other foot‐related conditions and few in nondiabetes populations.

Diabetes-related foot disease (DFD) is a leading cause of disability worldwide. In Australia, DFD affects approximately half a million people and is the primary driver of diabetes-related hospitalisations, amputations and costs. Guideline-based multidisciplinary footcare can halve these rates and improve quality of life, yet access remains inequitable, particularly for rural and remote communities for whom DFD hospitalisation and amputation rates are persistently high. Geographic isolation, workforce shortages and fragmented service delivery are barriers to DFD care, with Aboriginal and Torres Strait Islander Peoples experiencing additional cultural and systemic challenges. Telehealth-enabled models of care offer a promising solution to reducing inequities in access without compromising effectiveness. Four 'Foot Hubs' have been established across Queensland (Australia) to deliver specialist multidisciplinary footcare via a hub-and-spoke model, combining telehealth, outreach, and local partnerships to improve access for people living with DFD in rural and remote areas. This commentary provides an introductory overview of these Foot Hub services and how implementation science (the scientific study of methods and strategies to promote the systematic and sustainable uptake of new practices) can support the uptake and sustainability of these new models of care.

ABSTRACT Introduction Diabetes‐related foot disease is a leading cause of global disease burden, however the prevalence and incidence of diabetes‐related foot disease in Ireland is poorly understood. Up‐to‐date population‐level estimates of the incidence and prevalence are imperative to support appropriate health service planning. This study examined the prevalence and incidence of diabetes‐related foot disease in the Irish population. Methods We systematically searched Pubmed, EMBASE and Lenus the Irish Health Research repository, for peer‐reviewed articles published until August 2025. Publications reporting on prevalence and incidence of peripheral neuropathy, peripheral artery disease, foot ulceration or amputation in people with diabetes in Ireland, were eligible for inclusion. The Joanna Briggs Institute Prevalence (JBI) Critical Appraisal Tool was used to assess included studies methodological quality and establish the degree to which bias was addressed in the study's design and analysis. Results were synthesised descriptively according to study characteristics and outcomes. Results Three studies met the inclusion criteria (n = 145,945), with varying outcome measurement methods. In community‐based diabetes populations, peripheral neuropathy prevalence ranged from 15% to 39% (n = 1055) and peripheral artery disease prevalence ranged from 18% to 34% (n = 383). For the history of foot ulcers, prevalence was 3.7% (n = 563) and annual incidence was 2.6% (n = 383). One national population‐based study (n = 144,710) reported incidence of amputation increased from 144.2 to 175.7 per 100,000 people with diabetes between 2005 and 2009. Conclusion This review found there is a paucity of information on prevalence and incidence of diabetes‐related foot disease in Ireland. However, these findings suggest that prevalence is similar to, if not lower than, global rates of peripheral neuropathy, peripheral artery disease outcomes and amputation incidence outcomes. High heterogeneity in populations and outcomes highlights the need for robust studies and consensus on diabetes‐related foot outcome assessment. Establishing a national diabetes register could strengthen surveillance, identify high‐risk groups and inform cost‐effective public health planning. Trial Registration PROSPERO (CRD42023472904)

INTRODUCTION:People at risk of diabetes-related foot ulcers are recommended to always use therapeutic footwear when weight-bearing, to help prevent ulcers. These recommendations are supported by good quality evidence, yet adherence by patients to using this footwear is low. One reason may be because these recommendations do not consider that footwear use is highly contextual to the physical or sociocultural environments it is intended to be used. In this paper, we propose and discuss a contextual approach to considering therapeutic footwear solutions. CONTEXTUAL APPROACH TO THERAPEUTIC FOOTWEAR:Recommending patients to use the same therapeutic footwear solution in vastly different contexts seems at odds with person-centred care principles and is likely a reason for patients not fully adhering to such recommendations. We discuss seven contexts in which using therapeutic footwear is particularly challenging: the home, workplaces, social occasions, places-of-worship, water-related activities, hotter climates and holidays. We outline how a contextual approach to therapeutic footwear might lead to more appropriate footwear solutions. This approach typically involves a trade-off between functional benefits and adherence and may lead to novel designs for different contexts. We also propose six different footwear solutions that incorporate features that may be more aesthetically pleasing, cooler, lighter, cheaper or waterproof, yet still providing protection and functional offloading. We suggest outcomes of such an approach may be more favourable for the patient's overall adherence and foot health than the current somewhat unrealistic recommended practice of prescribing a "one shoe fits all" solution. CONCLUSION:A contextual approach as proposed in this paper may lead to novel therapeutic footwear solutions that better address patients' needs for adequate footwear. If these footwear solutions are implemented, this may in future lead to higher patient adherence to using appropriate footwear and lower ulceration rates.

BACKGROUND:Diabetes-related foot ulcers pose substantial health risks globally, yet the biomechanical intricacies underlying their development remain incompletely understood. This study aimed to evaluate lower limb gait joint coordination variability in individuals with diabetes-related foot ulcers compared to those with diabetes (without diabetes-related foot ulcers) and healthy controls. METHODS:A total of 99 participants (diabetes-related foot ulcers cases - 16, Diabetes controls - 50, Health controls - 33) compared three self-paced walking trials. Vector coding, a technique quantifying movement coordination, was employed, analysing hip-knee, knee-ankle, and hip-angle joint couplings in the sagittal plane. FINDINGS:No significant differences in coordination variability were found among the groups. However, distinct coupling pattern frequencies emerged, with diabetes-related foot ulcers cases exhibiting unique anti-phase hip and ankle coupling frequency counts compared to healthy controls. INTERPRETATION:These findings challenge conventional understandings of diabetes-related foot ulcers biomechanics and underscore the complexity of gait in this population.

Diabetes-related foot disease is arguably the world's least known major health problem and causes a disease burden larger than most well-known diseases, such as stroke and breast cancer. This burden is driven by people developing more severe stages of foot disease, such as foot ulcers and infections, and with that worsening quality of life. To reduce this burden, we need treatments that prevent more severe stages of foot disease and improve quality of life. Best practice offloading treatments have been found to be arguably the most effective existing treatments to heal and prevent diabetes-related foot ulcers and infections, but can worsen quality of life. Furthermore, high re-ulceration rates still occur with best practice offloading treatments after healing. This may be because of the gap in guideline recommendations on the transition from ulcer healing to ulcer remission when it comes to offloading treatments. In this paper, we review why we need offloading treatments and what are the best offloading treatments recommended by the latest international guidelines for healing and remission. Further, we propose plans for future best practice offloading treatments for the transition from healing-to-remission to help reduce re-ulceration rates and improve longer-term ulcer remission. These plans could be the catalyst for better transitioning patients from first ulcer presentation through healing and into long-term remission, and in turn delivering better quality of life, and lower diabetes-related foot disease burdens on patients, nations, and the globe in future.

Aim To achieve consensus on priorities for chronic wound research in Australia. Methods A three-round modified online Delphi survey using RAND/UCLA methods was undertaken to seek consensus from a random sample of Australian multidisciplinary expert chronic wound practitioners and researchers. Participants rated their agreement/disagreement on a nine-point Likert scale for each potential research topic. Customised software calculated median scale scores and 30-70% inter-percentile range for each item. Results A sample of 20 practitioners and researchers were invited and 12 agreed to participate. After three rounds, 102 topics achieved consensus as national priorities, including 26 items on diabetes-related foot ulcers, 25 on pressure injuries, 17 on mixed chronic wounds, and 16 on venous leg ulcers. The highest rated topics included pain management, compression therapy to prevent venous leg ulcers, pressure injury management for heels and wheelchair users, and compression therapy adherence. Conclusion This study found that while diabetes-related foot ulcers and pressure injury topics had the greatest number of consensus national priority topics for chronic wound research in Australia, pain management, compression therapy for venous leg ulcers and pressure injury management were the highest rated priorities. These findings could be used to target funding for national grant schemes.

OBJECTIVES:To assess the incidence, risk factors, and length of stay for hospitalisations, with and without amputations, of people with diabetes-related foot ulcers (DFU). STUDY DESIGN:Prospective observational cohort study; secondary analysis of linked Diabetic Foot Services and Queensland Hospital Admitted Patient Data Collection data. SETTINGS, PARTICIPANTS:All people with DFU who visited any of 65 outpatient Diabetic Foot Service clinics in Queensland for the first time during 1 July 2011 - 31 December 2017, followed until first DFU-related hospitalisation, ulcer healing, or death, censored at 24 months. MAIN OUTCOME MEASURES:First overnight hospitalisations for which the principal diagnosis was DFU-related (International Statistical Classification of Diseases, tenth revision, Australian modification; Australian Classification of Health Interventions codes), by amputation procedure type (none, minor [distal to ankle], major [proximal to ankle]). RESULTS:Among 4709 people with DFU (median age, 63 years (interquartile range [IQR], 54-72 years); 3275 men [69.5%]; type 2 diabetes, 4284 [91.0%]), DFU-related hospitalisations were recorded for 977 people (20.7%): 669 without amputations (68.5%), 258 with minor amputations (26.4%), and 50 with major amputations (5.1%). The incidence of first DFU-related hospitalisations was 50.8 (95% confidence interval [CI], 47.7-54.1) per 100 person-years lived with DFU before healing, death, or loss to follow-up. The incidence of first DFU-related hospitalisation with no amputation was 39.0 (95% CI, 36.2-42.1), with minor amputation 18.0 (95% CI, 17.0-20.0), and with major amputation 5.3 (95% CI, 4.4-6.3) per 100 person-years with DFU. The median length of stay for DFU-related hospitalisations was six (IQR, 3-12) days with no amputations, ten (IQR, 5-19) days with minor amputations, and 19 (IQR, 11-38) days with major amputations. The risks of all DFU-related hospitalisation outcomes were higher for people with deep ulcers or severe peripheral artery disease. The risks of DFU-related hospitalisation with no amputations were also greater for people aged 37-59 years than for those aged 60 years, and for people with cardiovascular disease, infections, or previous amputations; with minor amputations for people who smoked, had end-stage renal disease, previous amputations, moderate to severe infections, or peripheral artery disease, or who were not receiving knee-high offloading or DFU debridement treatments; and with major amputations for people with end-stage renal disease, peripheral artery disease, or larger ulcers. CONCLUSIONS:The incidence of DFU-related hospitalisations among people with DFU was high, and most did not involve amputations. Risk factor profiles differed between hospitalisations with or without amputation procedures. Our findings could assist services determine which people with DFU would benefit most from intensive interventions, potentially averting large numbers of diabetes-related hospitalisations.

INTRODUCTION:Foot disease is a leading cause of national disease burdens and is driven by diabetes. General practitioners (GPs) play a gatekeeper role in many national healthcare systems. Yet, national foot disease management by GPs has not been explored. We explored the management of foot disease by Australian GPs in people with and without diabetes. METHODS:We analysed 16 years of annual, cross-sectional, GP encounter data from the nationally representative Australian Bettering the Evaluation and Care of Health study in which a foot disease problem was managed. Factors independently associated with foot disease encounters by GPs were assessed using multivariable logistic regression. RESULTS:Foot disease management rates increased from 11.6 per 1000 GP encounters (95% CI: 10.8-12.5) in 2000-2001 to 14.4 (13.3-15.4) in 2015-2016 and 6.1 (5.7-6.6) to 8.7 (8.1-9.3) per 100 Australian people. The rate of GP foot disease management was 2.4-fold higher in people with diabetes compared to those without diabetes (31.5 [26.4-36.6] vs. 12.9 [11.8-14.0]). Foot disease encounters were positively associated with diabetes, male patients, older patients, English-speaking backgrounds and having healthcare concession cards (all, p < 0.05); for patients with diabetes, only males were positively associated. Most frequent management actions used were medications, procedures and pathology with referrals, counselling and imaging least frequent. CONCLUSIONS:Australian GP management rates for foot disease are higher than many more well-known health conditions and increasing. GPs frequently manage foot disease with medications and procedures, but relatively rarely counsel or refer. Future strategies to improve GP foot disease management and referrals are needed.

Diabetes-related foot disease (DFD) affects an estimated 110,000 people in Aotearoa New Zealand (Aotearoa NZ) and is one of the leading causes of the national disease burden. While guideline-based care has been found to significantly reduce DFD burdens around the world, Aotearoa NZ lacks national DFD guidelines. Instead, Aotearoa NZ clinicians tend to use either international guidelines or fragmented regional pathways of varying quality which result in variability in clinical practice. Given the higher impacts of DFD on Māori and Pacific peoples, and those in socioeconomically deprived or rural areas, national DFD guidelines incorporating Indigenous knowledge are urgently needed in Aotearoa NZ. We call for the urgent development of Aotearoa NZ DFD guidelines and propose methods to co-develop evidence-based guidelines integrating clinical expertise with Indigenous perspectives. This approach will enhance consistency, improve health outcomes, and support equitable DFD care in Aotearoa NZ.

Recent evidence suggests that diabetes-related lower-extremity complications (DRLECs) may be associated with cognitive changes in people with diabetes. However, existing literature has produced inconsistent findings, and no systematic reviews have been conducted to investigate whether DRLECs impact the cognition of people with diabetes. This systematic review evaluated existing studies that investigated cognition in people with diabetes with DRLECs and without DRLECs. Seven databases; MEDLINE, PubMed, CINAHL, EMBASE, Cochrane, PsycINFO and Web of Science were searched from inception until 22/8/2022 for studies that compared cognition in people with diabetes with and without DRLECs. Results were independently screened for eligibility and assessed for methodological quality by two authors, with key data extracted. Studies were eligible for meta-analysis if the studies reported similar cases, controls, and outcome measures. Thirteen studies were included in the review, with eleven of medium methodological quality, one of high quality, and one of low quality. Four studies found significant differences in cognition between those with and without DRLECs, four found significant associations between diabetes-related lower-extremity complications and cognition, and five found no differences or associations. One small meta-analysis of eligible studies found that there was no statistically significant difference in cognition in people without, compared to with, peripheral neuropathy (Mean difference = -0.49; 95

OBJECTIVE:To explore consultation patterns, management practices, and costs of foot, ankle, and leg problems in Australian primary care. STUDY DESIGN:We analyzed data from the Bettering the Evaluation and Care of Health program, April 2000 to March 2016. Foot, ankle, and leg problems were identified using the International Classification of Primary Care, Version 2 PLUS terminology. Data were summarized using descriptive statistics examining general practitioner (GP) and patient characteristics associated with a foot, ankle, or leg problem being managed. Cost to government was estimated by extracting fees for GP consultations, diagnostic imaging, and pathology services from the Medicare Benefits Schedule (MBS) database. Costs for prescription-only medicines were extracted from the Pharmaceutical Benefits Schedule and for nonprescribed medications, large banner discount pharmacy prices were used. RESULTS:GPs recorded 1,568,100 patient encounters, at which 50,877 foot, ankle, or leg problems were managed at a rate of 3.24 (95% confidence intervals [CIs] 3.21-3.28) per 100 encounters. The management rate of foot, ankle, or leg problems was higher for certain patient characteristics (older, having a health care card, socioeconomically disadvantaged, non-Indigenous, and being English speaking) and GP characteristics (male sex, older age, and Australian graduate). The most frequently used management practice was the use of medications. The average cost (Australian dollars) per encounter was A$52, with the total annual cost estimated at A$256m. CONCLUSIONS:Foot, ankle, and leg problems are frequently managed by GPs, and the costs associated with their management represent a substantial economic impact in Australian primary care.

Reducing high mechanical stress is imperative to heal diabetes-related foot ulcers. We explored the association of cumulative plantar tissue stress (CPTS) and plantar foot ulcer healing, and the feasibility of measuring CPTS, in two prospective cohort studies (Australia (AU) and The Netherlands (NL)). Both studies used multiple sensors to measure factors to determine CPTS: plantar pressures, weight-bearing activities, and adherence to offloading treatments, with thermal stress response also measured to estimate shear stress in the AU-study. The primary outcome was ulcer healing at 12 weeks. Twenty-five participants were recruited: 13 in the AU-study and 12 in the NL-study. CPTS data were complete for five participants (38%) at baseline and one (8%) during follow-up in the AU-study, and one (8%) at baseline and zero (0%) during follow-up in the NL-study. Reasons for low completion at baseline were technical issues (AU-study: 31%, NL-study: 50%), non-adherent participants (15% and 8%) or combinations (15% and 33%); and at follow-up refusal of participants (62% and 25%). These underpowered findings showed that CPTS was non-significantly lower in people who healed compared with non-healed people (457 [117; 727], 679 [312; 1327] MPa·s/day). Current feasibility of CPTS seems low, given technical challenges and non-adherence, which may reflect the burden of treating diabetes-related foot ulcers.

AbstractBackgroundDiabetes‐related foot disease (DFD) is a leading cause of the Australian and global disease burdens and requires proportionate volumes of research to address. Bibliometric analyses are rigorous methods for exploring total research publications in a field to help identify volume trends, gaps and emerging areas of need. This bibliometric review aimed to explore the volume, authors, institutions, journals, collaborating countries, research types and funding sources of Australian publications investigating DFD over 50 years.MethodsA systematic search of the Scopus® database was conducted by two independent authors to identify all Australian DFD literature published between 1970 and 2023. Bibliometric meta‐data were extracted from Scopus®, analyzed in Biblioshiny, an R Statistical Software interface, and publication volumes, authors, institutions, journals and collaborative countries were described. Publications were also categorised for research type and funding source.ResultsOverall, 332 eligible publications were included. Publication volume increased steadily over time, with largest volumes (78%) and a 7‐fold increase over the last decade. Mean co‐authors per publication was 5.6, mean journal impact factor was 2.9 and median citation was 9 (IQR2‐24). Most frequent authors were Peter Lazzarini (14%), Vivienne Chuter (8%) and Jonathon Golledge (7%). Most frequent institutions affiliated were Queensland University Technology (33%), University Sydney (30%) and James Cook University (25%). Most frequent journals published in were Journal Foot and Ankle Research (17%), Diabetic Medicine (7%), Journal Diabetes and its Complications (4%) and International Wound Journal (4%). Most frequent collaborating countries were the United Kingdom (9%), the Netherlands (6%) and the United States (5%). Leading research types were etiology (38%), treatment evaluation (25%) and health services research (13%). Leading funding sources were no funding (60%), internal institution (16%) and industry/philanthropic/international (10%).ConclusionsAustralian DFD research increased steadily until more dramatic increases were seen over the past decade. Most research received no funding and mainly investigated etiology, existing treatments or health services. Australian DFD researchers appear to be very productive, particularly in recent times, despite minimal funding indicating their resilience. However, if the field is to continue to rapidly grow and address the very large national DFD burden, much more research funding is needed in Australia, especially targeting prevention and clinical trials of new treatments in DFD.

IntroductionMinor amputation is commonly needed to treat diabetes-related foot disease (DFD). Remoteness of residence is known to limit access to healthcare and has previously been associated with poor outcomes. The primary aim of this study was to examine the associations between ethnicity and remoteness of residency with the risk of major amputation and death following initial treatment of DFD by minor amputation. A secondary aim was to identify risk factors for major amputation and death following minor amputation to treat DFD.Research design and methodsThis was a retrospective analysis of data from patients who required a minor amputation to treat DFD between 2000 and 2019 at a regional tertiary hospital in Queensland, Australia. Baseline characteristics were collected together with remoteness of residence and ethnicity. Remoteness was classified according to the 2019 Modified Monash Model (MMM) system. Ethnicity was based on self-identification as an Aboriginal and Torres Strait Islander or non-Indigenous person. The outcomes of major amputation, repeat minor amputation and death were examined using Cox-proportional hazard analyses.ResultsA total of 534 participants were included, with 306 (57.3%) residing in metropolitan or regional centres, 228 (42.7%) in rural and remote communities and 144 (27.0%) were Aboriginal or Torres Strait Islander people. During a median (inter quartile range) follow-up of 4.0 (2.1-7.6) years, 103 participants (19.3%) had major amputation, 230 (43.1%) had repeat minor amputation and 250 (46.8%) died. The risks (hazard ratio [95% CI]) of major amputation and death were not significantly higher in participants residing in rural and remote areas (0.97, 0.67-1.47; and 0.98, 0.76-1.26) or in Aboriginal or Torres Strait Islander people (HR 1.44, 95% CI 0.96, 2.16 and HR 0.89, 95% CI 0.67, 1.18). Ischemic heart disease (IHD), peripheral artery disease (PAD), osteomyelitis and foot ulceration (p<0.001 in all instances) were independent risk factors for major amputation.ConclusionMajor amputation and death are common following minor amputation to treat DFD and people with IHD, PAD and osteomyelitis have an increased risk of major amputation. Aboriginal and Torres Strait Islander People and residents of remote areas were not at excess risk of major amputation.

This study aimed to investigate the levels of adherence to wearing therapeutic footwear, and the factors associated, among people at high-risk of diabetes-related foot ulcers (DFUs) in Jordan. This was a secondary analysis of data from a multi-centre cross-sectional study of participants at high-risk of DFU in Jordan who had therapeutic footwear. Participants had socio-demographic, health, limb, and psychosocial variables collected, plus self-reported their proportion of adherence time wearing therapeutic footwear on an average day (excluding sleeping time) using a visual analogue scale. Participants were categorized into high (≥60%) or low (<60%) adherence levels, plus users (1%-100% adherence) or non-users (0% adherence) of therapeutic footwear. Of 104 included participants (mean age 58 ± 13 years, 68% males), 65 (62.5%) self-reported low adherence levels and 44 (42.3%) as non-users. No variables were independently associated with low adherence levels (P > .05). Whereas participants with lower self-reported foot care outcome expectation scores were independently associated with non-use of therapeutic footwear (P = .05). Most people at high-risk of DFUs in Jordan self-reported low adherence or total non-use of their therapeutic footwear. Perceived low footcare outcome expectations was the only factor found associated with non-use of therapeutic footwear and further research is needed to explore other potential factors.

In this podcast the lead authors of the 2023 International Working Group on the Diabetic Foot (IWGDF) guideline on offloading treatments for diabetes-related foot ulcers briefly discuss why we need offloading treatments for people with diabetes-related foot ulcers, what the new international offloading guideline recommends, and where offloading treatment might go into the future. A podcast audio is available with this article.

Objective: This retrospective cohort study investigated the anatomical distribution, severity, and outcome of peripheral artery disease (PAD) in Aboriginal and Torres Strait Islanders compared with non-indigenous Australians.Methods: The distribution, severity, and outcome of PAD were assessed using a validated angiographic scoring system and review of medical records in a cohort of Aboriginal and Torres Strait Islander and non-indigenous Australians. The relationship between ethnicity and PAD severity, distribution, and outcome were examined using non-parametric statistical tests, Kaplan-Meier and Cox proportional hazard analyses.Results: Seventy-three Aboriginal and Torres Strait Islanders and 242 non-indigenous Australians were included and followed for a median of 6.7 [IQR 2.7, 9.3] years. Aboriginal and Torres Strait Islander patients were more likely to present with symptoms of chronic limb threatening ischaemia (81% vs. 25%; p < .001), had greater median [IQR] angiographic scores for the symptomatic limb (7 [5, 10] vs. 4 [2, 7]) and tibial arteries (5 [2, 6] vs. 2 [0, 4]) and had higher risk of major amputation (HR 6.1, 95% CI 3.6 -10.5; p < .001) and major adverse cardiovascular events (HR 1.5, 95% CI 1.0 -2.3; p = .036) but not for revascularisation (HR 0.8, 95% CI 0.5 -1.3; p = .37) compared with non-indigenous Australians. The associations with major amputation and major adverse cardiovascular events were no longer statistically significant when adjusted for limb angiographic score.Conclusion: Compared with non-indigenous patients, Aboriginal and Torres Strait Islander Australians had more severe tibial artery disease and a higher risk of major amputation and major adverse cardiovascular events.