Unmasking the impact of clinical non-attendance on neuropathic diabetes foot ulcer management

Abstract

This negative case study illustrates the far-reaching impact of poor clinical attendance on the management of neuropathic diabetes foot ulceration (DFU), reinforcing key priorities for clinical care. While a weekly hospital-based podiatry and/or multidisciplinary diabetes foot ulcer clinic (MDFC) review remained the local standard, in this case, failure to attend scheduled appointments proved to be the rule, rather than the exception. Sporadic podiatry and MDFC clinical attendance prevented regular expert foot assessment, sharp wound debridement, timely microbiological sampling, antibiotic monitoring and total contact casting (TCC); essential cornerstones of ‘best practice.’ Opportunistic wound surface area (SA) measurement demonstrated subsequent failure to heal over a 306-day period. This case study reinforces the adage that, when it comes to DFU management, “it’s not what you put on, it’s what you take off.” Let this individual’s inappropriately self-applied masking tape serve as a metaphor for the perils of TCC when clinical attendance is poor. Applied ironically to improve adherence, this tape caused restriction, maceration, an ideal breeding ground for bacteria and prevented timely wound assessment. Coupled with irregular expert review, this masking tape illustrates the importance of appropriate patient selection when electing for a TCC to manage neuropathic DFU.