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Objective: Most podiatry‐led high‐risk foot services (HRFS) in Australia are located in metropolitan areas or large regional centres. In rural areas, where there are limited specialist services, individuals with diabetes‐related foot ulceration are more likely to undergo amputation. This study aimed to explore clinicians' perceptions of a recently implemented HRFS in rural New South Wales, Australia, and compare trends of amputation and hospitalisation prior to and post‐implementation of the service. Setting: Rural HRFS in Tamworth, New South Wales, Australia. Participants: Health professionals working within the HRFS were recruited to participate. Design: This was a multiple‐methods study. For the qualitative arm, semi‐structured interviews were conducted, which were analysed using a reflexive thematic approach. The quantitative arm of the study utilised a retrospective analytic design which applied an interrupted time series to compare amputation and hospitalisation trends pre‐ and post‐implementation of the HRFS utilising diagnostic and procedural ICD codes. Results: The qualitative arm of the study derived three themes: (1) navigating the divide, (2) rural community and rural challenges and (3) professional identity. Results of the interrupted time series indicate that there was a downward trend in major amputations following implementation of the HRFS; however, this was not statistically significant. Conclusion: Clinicians were aware of the inequity in DFD outcomes between rural and metropolitan areas and were committed to improving outcomes, particularly with respect to First Nations peoples. Future research will explore service use and amputation rates in the longer term to further evaluate this specialised multidisciplinary care in a rural community. [ABSTRACT FROM AUTHOR]

Objective: Diabetes‐related foot ulceration (DFU) is a common limb‐threatening condition, which is complex and subsequently challenging to manage. The aim of this study was to determine the contribution of a range of clinical and social factors to the healing of diabetes‐related foot ulceration in an Australian population. Research design and methods: This was a prospective cohort study of individuals with diabetes‐related foot ulceration (DFU). Age, sex, medical history, medications, dietary supplementation (e.g. vitamin C intake) and smoking history were elicited at baseline. The index of relative socio‐economic disadvantage (IRSD) was calculated. The Australian Eating Survey and International Physical Activity Questionnaire‐short were administered. Wound history, size, grade, time to healing and infection were captured and monitored over 6 months. Logistic regression was performed to determine the relationship between healing and diet quality, toe systolic pressure, wound size at, IRSD, infection and previous amputation. Results: A total of 117 participants were included. The majority were male n = 96 (82%), socio‐economically disadvantaged (mean IRSD 965, SD 60), and obese (BMI 36 kg/m2, SD 11) with a long history of diabetes (20 years, SD 11). Wounds were predominantly neuropathic (n = 85, 73%) and classified 1A (n = 63, 54%) on the University of Texas wound classification system with few infections (n = 23, 16%). Dietary supplementation was associated with 4.36 increased odds of healing (95% 1.28–14.84, p = 0.02), and greater levels of socio‐economic advantage were also associated with increased odds of healing (OR 1.01, 95% CI 1.01–1.02, p = 0.03). Conclusions: In this cohort study of predominantly neuropathic, non‐infected DFU, individuals who had greater levels of socio‐economic advantage had significantly greater odds of DFU healing. Diet quality was poor in most participants, with individuals taking supplementation significantly more likely to heal. [ABSTRACT FROM AUTHOR]

Background: Adequate nutrition is essential in individuals with diabetic foot ulceration (DFU); therefore, an assessment of dietary intake is critical. A lack of nutrients including protein, zinc and vitamins C and D have all been associated with poor wound healing. However, the comprehensive dietary intake of Australian adults with DFU is poorly understood. The aim of this cross‐sectional study was to describe the dietary intake of adults with DFU in an Australian setting. Methods: Participants (n = 115) with diabetes (type 1 and 2), a mean body mass index of 36 and current foot ulceration were recruited from across New South Wales, Australia. Dietary intake was assessed using the Australian Eating Survey, a self‐reported validated food frequency questionnaire. Results: The mean (SD) reported energy intake was 9.57 (±SD 4.43) MJ day–1. A mean protein intake of 104 (±SD 49) g day–1 is below recommended intake for wound healing; however, the mean protein intake contribution to energy (19%E) was within recommendations for normal populations. The mean carbohydrate intake (43%E) was within recommended ranges for healthy populations; however, the mean total fat intake (36%E) was above recommendations. Micronutrient intake was adequate, apart from folate, which was below the recommended intake, and sodium, vitamin C, vitamin A and selenium, which were above the recommended intake. Conclusions: A lack of adequate folate may have a negative impact on healing, with folate proposed to play a role in tissue repair. Wound management of individuals with DFU should include a regular assessment of dietary intake to recognise deficiencies in macro‐ and micronutrients, and subsequently address these inadequacies to optimise healing. Key points: This cross‐sectional study of 115 participants with active diabetic foot ulceration aimed to describe current dietary intake.Utilising a validated food frequency questionnaire, the Australian Eating Survey, it was found that mean protein intake was inadequate for wound healing (9.57 MJ day–1).Intake of folate was also inadequate, which may have implications for tissue repair.Wound management of individuals with diabetic foot ulceration should include an assessment of dietary intake to recognise deficiencies in macro‐ and micronutrient intake and subsequently address these to optimise healing outcomes. [ABSTRACT FROM AUTHOR]

Australia has the second highest rate of non‐traumatic lower extremity amputation (LEA) globally. Australia's large geographical size is one of the biggest challenges facing limb preservation services and may be contributing to LEA. The aim of this study was to determine what factors contribute to the likelihood of LEA in people with active foot ulceration in regional Australia. This retrospective cohort study audited patients with active foot ulceration in a multidisciplinary high risk foot service (HRFS) in regional Australia. Neurological, vascular and wound characteristics were systematically extracted, along with demographic information. Participants were followed for at least 12 months until healing or LEA occurred. Correlations between LEA and clinical and demographic characteristics were assessed using the Pearson's product moment correlation coefficient and chi squared test for independence. Significant variables (p < 0.05) were included in the model. Direct logistic regression assessed the independent contribution of significantly correlated variables on the likelihood of LEA. Of note, 1876 records were hand screened with 476 participants (25%) meeting the inclusion criteria. Geographical distance from the HRFS, toe systolic pressure (TSP), diabetes and infection were all significantly correlated with LEA and included in the logistic regression model. TSP decrease of 1 mmHg (OR 1.02, 95% CI 1.01–1.03), increased geographical distance (1 km) from HRFS (OR 1.006, 95% CI 1.001–1.01) infection (OR 2.08, 95% CI 1.06–4.07) and presence of diabetes (OR 3.77, 95% CI 1.12–12.65) were all significantly associated with increased likelihood of LEA. HRFS should account for the disparity in outcomes between patients living in close proximity to their service, compared to those in rural areas. Optimal management of diabetes, vascular perfusion and control of infection may also contribute to preventing LEA in people with active foot ulceration. [ABSTRACT FROM AUTHOR]