Thread by @DiabetesKings

As we celebrate the 40th anniversary of the King’s Diabetic Foot Clinic, Professor Mike Edmonds explores in his first tweetorial the history of the clinic and a selection of significant milestones. @KingsCollegeNHS

The multidisciplinary Diabetic Foot Clinic at @KingsCollegeNHS was established with the support of @DiabetesUK (then the British Diabetic Association) in May 1981.
academic.oup.com/qjmed/article-…

The Diabetic Foot Clinic has had 3 aims:
1) to develop best possible care for people with diabetic foot problems

2) to research into the causes of and devise new treatments for the diabetic foot

3) to teach health care professionals best care of foot problems

The Diabetic Foot Clinic brought together skills of podiatrist, nurse, orthotist, vascular/orthopaedic/plastic surgeon, radiologist, diabetologist, dermatologist, microbiologist, vascular scientist, pharmacist, physiotherapist and rheumatologist. @KingsCollegeNHS

The Clinic achieved a 50% reduction of major amputations from 1981 to 1984 and ongoing year on year improvements in major amputation rates. @KingsCollegeNHS
wchh.onlinelibrary.wiley.com/doi/full/10.10…

There has been a reduction in percentage of clinic attendees undergoing major amputation over the years (1989-2014)

It offers a wide range of clinics, dedicated ward beds attended by diabetic foot practitioners and multidisciplinary meetings covering all aspects of diabetic foot care. @KingsCollegeNHS
doi.org/10.1177%2F1534…

The Diabetic Foot Clinic operates open access service, encourages self-referrals &seeing emergencies the same day/within 24hrs. It evolved into a Day Unit delivering a "one-stop", same day service where investigations are performed, results reviewed &treatment plans implemented

New pts(formal referral) spend longer Rx time in the unit than self-referral emergency new pts

“Emergency new self-referrals” are likely in a less advanced clinical state vs “regular new patient referral”.

doi.org/10.1177%2F1534…

The open-access policy empowers patients to present early and therefore potentially reducing complexity and risk of deterioration by the time of presentation to the Clinic.
doi.org/10.1177%2F1534…

The podiatrists have successfully pioneered (since 1986) the use of the total contact cast to heal neuropathic ulcers and Charcot feet (Picture courtesy of Maureen Bates and Ali Foster)
onlinelibrary.wiley.com/doi/epdf/10.11…

Joint vascular-diabetic foot clinics are held to manage the ischaemic lower limb of diabetes which has been revascularised by below knee and recently by below ankle angioplasty and arterial bypass.
ejves.com/article/S1078-…

Interventional radiology has played a significant part in revascularisation of the lower limb extending techniques to the crural arteries and recently to the foot arteries. (DY Huang, CJ Wilkins, DR Evans, Ammar T et al) @KingsCollegeNHS
ncbi.nlm.nih.gov/pmc/articles/P…

Charcot neuroarthropathy is a debilitating condition. The deformed Charcot foot has been treated surgically @KingsCollegeNHS since 2007 by long segment rigid internal stabilisation with optimal bone opposition. @VenuKavarthapu
doi.org/10.1302/0301-6…

The Clinic has had a strong educational role, receiving visitors from many parts of the world. It has and continues to collaborate with a wide range of healthcare professionals (HCPs) and stakeholders locally and globally to improve care of people with d diabetic foot disease.

To support education, the clinic has produced several books (examples):

A Practical Manual Of Diabetic Foot Care (@TheBMA Medical Book of the Year 2004)

Managing the Diabetic Foot

Diabetic Foot Care: Case Studies in Clinical Mx

amzn.to/3wfmTmA

Laboratory research engendered by the clinic has employed advances in cellular biology to elaborate osteoclast function in Charcot foot (Nina Petrova)
bit.ly/2RntpsU

Smooth muscle cell-mediated vascular calcification. (Shanahan CM, Salisbury JR)
bit.ly/3f1Bexc

As we enter the 5th decade of the clinic & the service @KingsCollegeNHS, it is important to keep the person with diabetes at the core of everything we do and continue to collaborate, innovate, and inspire the future generation of clinicians to deliver the best care and outcomes.

Epilogue from Jean-Martin Charcot

(Sanders LJ. What lessons can history teach us about the Charcot foot? Clin Podiatr Med Surg. 2008 Jan;25(1):1-15
researchgate.net/publication/56…)