Global Diabetes Foot Training Programme

Management of the foot in diabetes is a neglected condition, the world over. The interplay between infection, ischaemia, glycaemic control, neuropathy, bony deformities, ulceration, issues of gait and footwear make it medical sciences most challenging disorder. The presence of ulceration and the process of healing needs special attention. Moreover, in case of progression, amputation is sometimes indicated, and the risk of subsequent morbidity and mortality is high, despite recovery and rehabilitation following amputation.

The Christian Medical College at Vellore has the experience of handling the foot in diabetes, over many years. The legacy of Paul Brand, which has grown out of the treatment and management of leprosy from the 1940s, has been progressively transcribed to the management of the foot in diabetes. Treatment of foot ulcers and neuropathy, and the principles of offloading with appropriate footwear and prosthesis can make a major difference in the outcome of management of the foot in diabetes. The integrated management of the foot in diabetes involves the collaborative capacity of doctors along with nurses and paramedics. The major deficiency in management of the foot in diabetes the world over is the absence of the ability to manufacture customized footwear and prosthesis.

We have a dream that, there may be multidisciplinary teams that can handle the management of the diabetes foot the world over, coupled with the ability of healthcare centres have technical staff who can to the very basics in terms of manufacturing customized footwear.

This training program is being organized by the Department of Endocrinology, Diabetes and Metabolism & Distance Education at the Christian Medical College Vellore in India in collaboration with Vascular Surgery, General Surgery-1, and Prosthetics and Orthotics and Physical Medicine and Rehabilitation.

Phase-I: -

Foundational Online training for Doctors, Nurses, and Physiotherapists on judicious management of the diabetes foot and utilization of footwear, taken by experts in the area, and will be conducted online. (2 hours a week for 4 weeks);

The Curriculum includes:

• Peripheral Neuropathy
• Pre-ulcer state
• Peripheral Vascular Disease
• Osteomyelitis of Foot
• Charcot Foot
• Medical Offloading
• Necrotising fasciitis & surgeries
• A detailed Pre-test and Post-test evaluation

Foundational Online training for Doctors, Nurses, and Physiotherapists on judicious management of the diabetes foot and utilization of footwear, taken by experts in the area, and will be conducted online. (2 hours a week for 4 weeks). There is no ceiling on the number of registrations per institution provided each individual registers and remits.

There is no ceiling on the number of registrations per institution provided each individual registers and remits.

You should participate as a team, there should be at least one doctor and one nurse/physiotherapist as part of the team. You can have more than one doctor or nurse from your centre. At the end of the course, you will have acquired the basic skills preventive and therapeutic aspects of handling the diabetes foot and the primary skills required for teamwork in handling the diabetes foot. The Course material will include online presentations and videos. You will receive PDF copies of the training material. Plus, a copy of the book:

You will need to have 100% attendance of all 8 hours of the course and pass marks (50%) as an aggregate of all the post tests to attain the: Foundational Certificate in Diabetes Foot Care.

Phase-2a: -

Intermediate to Advanced level training in management of the diabetes foot.
To qualify for this phase, you will have had acquired the Foundational Certificate in Diabetes Foot Care through phase 1 of this training programme. You will have to attend this programme as teams from your hospital as one doctor and one nurse/ physiotherapist from you centre. You will have to organize your travel and stay in Vellore; however, your entire training programme will be subsidized.

The course will be a hands-on programme, with some theoretical concepts and a good amount of hands-on training with patients having problems of the diabetes foot. Sessions will be conducted by faculty from the departments of endocrinology, vascular surgery, general surgery, Prosthetics and orthotics, plastic surgery and Physical medicine and rehabilitation. The programme will run for 4 full days from Tuesday to Friday and will involve experience in the diabetes foot clinic, vascular laboratory, orthotic centre and physical Medicine and rehabilitation centre. There will be a theoretical and a practical evaluation at the end of the programme. An Intermediate Level Certificate in Diabetes foot care will be provided at the end of the training programme.

Phase-2b: -

Two-day workshops and continuing medical education with practical demonstrations will be conducted by the team from CMC, Vellore at peripheral centres across the country, who will be identified as potential training partners with CMC, Vellore in the professional management of the diabetes foot. These centres will subsequently act as trainers in the management of diabetes care, for other health care professionals across the country.

Phase-3: -

Development and nurture of existing prosthetic and orthotic centres across the country in the manufacture of customized footwear and prothesis. The prosthetic and orthotic centres in CMC Vellore and CMC Vellore-Chittoor campus, along with the orthotic centres run by some of the Leprosy mission hospitals will develop a blueprint in enabling providing footwear and prosthesis and also training orthoticians and shoemakers across the country to work with health care givers in improving the management of the foot in diabetes.