Meet The Diabetic Foot Clinic Multidisciplinary Team at King’s College Hospital

The three main aims of the Diabetic Foot Clinic are:

  • To provide the best possible care for patients with diabetic foot problems
  • To teach and train healthcare professionals to provide a high quality service
  • To research the causes of diabetic foot syndrome and associated health issues

The not-so-secrets of our success:

1. Offering a rapid and open access service with early diagnosis and urgent treatment

2. Using a multi-disciplinary approach to get the right specialists in the room, at the right time, working together with the patient at the centre

Our MDT — the ‘foot soldiers’:

Diabetologists — Professor Michael Edmonds and Dr Prash Vas

“We play a special role in understanding, managing and coordinating the care of our patients. We are responsible for the rapid diagnosis of infection and ischaemia to enable prompt treatment of infection, as well as treating neuropathic pain. We also decide which patients require urgent admission to hospital and are then responsible for overseeing their care on the wards.”

Podiatrist — Maureen Bates

“We are the gatekeepers of the clinic — making initial assessments for both emergency patients and those with planned appointments. We begin initial treatment including debridement, exploration and dressing foot ulcers, before ensuring that appropriate members of the MDT are brought in to jointly support the patient. We also construct plaster casts to take pressure off neuropathic ulcers on the sole of the foot and to help stabilise and prevent deformity of neuropathic joints.”

Clinic Nurse — Ian Alejandro

“In the clinic I administer intravenous antibiotics and am responsible for taking care of the peripherally inserted central catheters (PICC) lines through which these drugs are given. I monitor patients who are unwell during clinic and treat leg ulcers as well as applying compression bandaging. I also lead our home intravenous antibiotic programme through liaison with community nurses.”

Interventional Radiologist — Dr Dean Huang

“My role is varied and is a combination of providing advice and implementing medical procedures. I lead the multi-disciplinary vascular radiology meeting and am responsible for making joint decision with my colleagues regarding surgical vascular interventions. I also advise on and perform vascular imaging, angioplasties and stenting.”

Clinical Specialist Orthotist — Christian Pankhurst

“I bring my knowledge and understanding of pathology, biomechanics and engineering to the team. My aim is to improve the function and comfort of the patient, from giving simple advice on foot care and footwear, to providing more extensive and custom orthoses to improve weight and pressure distribution, support unstable or painful joints and compensate for weak or absent muscles.”

Vascular Surgeon — Hisham Rashid

“Part of my role is to provide support for the one-stop-shop joint vascular diabetic foot service — I carry out investigations, review results and implement treatment — all in the same day. This is one of several multidisciplinary clinics I perform, as well as surgical duties which include arterial bypasses of blocked arteries in the leg and foot, and debriding infected feet with reduced circulation.”

Orthopaedic Surgeon — Venu Kavarthapu

“I take part in regular joint multidisciplinary clinics and ward rounds where specialist orthopaedic surgical input is required for patient with complex diabetic foot needs. In terms of surgical activity I am responsible for correcting forefoot abnormalities and reconstructing severely deformed Charcot feet — a rare complication of neuropathy in diabetes. I also debride infected neuropathic feet.”

Plastic Surgeon — Mr Naveen Cavale

“I provide advice and expertise on all aspects of plastic surgery relating to the diabetic foot both in joint multidisciplinary clinics as well as on ward rounds. In theatre I debride neuropathic feet and carry out skin grafts and free tissue transfer. Not many people think of plastic surgery when they think of diabetic feet, but it has a key role to play in reconstruction and ensuring future resilience.”

No single person can treat the diabetic foot… successful management needs the expertise of a multidisciplinary team, working closely together not only in the outpatient diabetic foot clinic, but also in inpatient areas including wards, operating theatres and angiography suites. We believe our model can be easily adapted and developed in larger district and teaching hospitals, and we are proactive in sharing our knowledge and experience with other organisations. Visitors to our clinic have been able to remodel their own service, resulting in a subsequent reduction in amputation rates. We think our work and reputation speaks for itself, we see over 6,000 patients each year — a very high throughput for a service of our size — and have won numerous awards for our outstanding contributions to patient care.

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