SLR - May 2021 - Andrew Mermelstein

Application of Tele-Podiatry in Diabetic Foot Management: A Series of Illustrative Cases

Reference: Kavitha, KV, Deshpande SR, Pandit, AP, Unnikrishnan AG. Application of Tele-Podiatry in Diabetic Foot Management: A Series of Illustrative Cases. Diabetes Metab Syndr 2020; 14(6): 1991–1995. doi: 10.1016/j.dsx.2020.10.009

Level of Evidence: Level 5, Case series with no controls

Scientific Literature Review

Reviewed By: Andrew Mermelstein, DPM
Residency Program: Roxborough Memorial Hospital – Philadelphia, PA

Podiatric Relevance: This article studies the effectiveness for tele-podiatry during the unprecedented times of the Covid-19 pandemic. There has been great apprehension by patients to follow up in office due to exposure of the virus. This had led to delay or absence of podiatric care in diabetics especially. In these scenarios, ulcerations in particular can lead to an increase in hospital admissions, more severe amputations and increased mortality rates. The purpose of this sturdy is to explore how effective telemedicine is in the realm of podiatric medicine. 

Methods: This study evaluates three case series which examine the effectiveness in the ability of podiatric medicine to successfully treat patients via tele-health. Case number one was a 66-year-old male with a 10-year history of type two diabetes with peripheral neuropathy seen for an injury of the left hallux. Case number two was a 73-year-old female with a past medical history of diabetes with peripheral neuropathy, peripheral vascular disease, previous foot ulcer, and amputation of bilateral hallux. Case number three was a 79-year-old male with past medical history of type two diabetes and dementia who is home-bound. 

Results: This study found tele-podiatry to be effective in certain scenarios but had drawbacks and limitations. It was particularly effective in those with lower-level issues with foot ulcers and yielded good results for referring for higher risk pedal issues. 

Conclusions: In summary, the Covid-19 pandemic has transformed the medical landscape with the use of virtual medicine. There are numerous benefits to telemedicine including easy access from a remote location, no transportation needed in most cases, and a safe environment for both practitioners and patients. Numerous studies have shown that telemedicine can improve overall outcomes, especially in high-risk patients, such as diabetics. However, there are great limitations to the use of telemedicine for podiatric care. These include limited ability to physically assess the wound such as any probing, tunneling or tracking, odor, or temperature of the limb. Furthermore, the colors via photos or videos may be deceiving and not truly reflect actual colors for proper wound assessment. Therefore, the article cites telemedicine as beneficial for podiatric medicine but its use as a standalone diagnostic tool is not effective. The true long-term value and efficacy of telemedicine still remains to be determined in the diabetic wound care setting. 

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