The nuances of wound and foot care in diabetes for individuals with dark skin tone are increasingly being recognised as a critical area for upskilling. This need for specialised knowledge was highlighted by Wounds International in the recent international consensus document addressing wound care and skin tone signs, symptoms, and terminology for all skin tones (Dhoonmoon, Nair, Abbas et al 2023). Two of the authors of the consensus document contributed to the Diabetes Footcare in Dark Skin Tone handbook, published by Diabetes Africa (Figure 1).
This handbook offers healthcare professionals an accessible approach to managing diabetes-related foot complications in people with dark skin. Designed to be an easy read, the handbook combines basic knowledge, case studies, expert insights, and practical tools, along with audio and images to facilitate learning.
To inform the content of the handbook, fifty healthcare professionals from diverse cultural settings were surveyed about the challenges of diabetes foot care. Their feedback emphasised the need for a visual guide to recognise conditions on different skin tones, which now forms the core of the handbook.
The handbook’s nine authors and reviewers include specialists from primary, secondary, and tertiary care, as well as an individual living with diabetes (Figure 2). All have extensive experience in diabetes foot care and have contributed to significant publications, campaigns and research on the topic.
Understanding the need for specialised care
The rationale for the handbook is clear: over 550 million people worldwide live with diabetes. Each year, 18.6 million of them (approximately 3%) will develop a foot ulcer. Globally, the mortality rate among those who have undergone a major limb amputation due to a diabetes-related foot ulcer is alarmingly high: over 50% will die within five years. The five-year mortality rate for diabetes-related foot ulcers is 30.5% (Armstrong et al, 2020).
However, the presentation of diabetes and its complications on feet can vary significantly based on skin tone, necessitating tailored approaches. The handbook addresses this by providing guidance on recognizing and managing foot issues in dark skin tones, where symptoms like redness may not be as apparent.
Case studies and expert insights
To bring the advice and guidance to life, the handbook comprises case studies that provide practical examples of diabetes-related foot conditions in dark skin tones but also across a range of skin tones (Figure 3).
These case studies, anonymized to protect individual privacy, are accompanied by high-quality illustrations and descriptions. They not only highlight the visual differences but also emphasize the importance of early detection and intervention.
Understanding when to seek a second opinion or pursue further tests is a crucial aspect of care. Much of this knowledge comes with experience. This handbook will accelerate that learning curve for many.
Resources for ongoing education and support
Beyond the practical guidelines and case studies, the handbook also provides a wealth of additional resources.
The handbook offers culturally sensitive tips for taking individual histories and a list of examination prompts. At the recent launch event, attendees emphasised the need for sensitivity to people’s backgrounds and beliefs. One professional noted: “the individuals we see may feel embarrassed by infection-related changes and hide the affected leg or foot.” The handbook underscores the role of empathy and awareness in providing effective and respectful healthcare.
Healthcare professionals are encouraged to engage with the broader diabetes care community through social media and direct feedback channels. The handbook’s commitment to continuous improvement and adaptation is evident in its call for user experiences and ideas.
A walk-through of a diabetes foot clinic
One of the standout features of the handbook is the walk-through of a diabetes foot clinic led by Luxmi Dhoonmoon, Tissue Viability Nurse Consultant at London North West University Healthcare NHS Trust. Readers are invited to listen to a recording of the consultant as she provides her clinical procedures and considerations when undertaking an examination of a person with dark skin tone and diabetes-related foot complications.
Innovative tools and visual aids
The handbook introduces several tools to aid in the accurate diagnosis and treatment of foot conditions. For example, the Skin Tone Tool by Ho & Robinson (2015) is highlighted as a critical resource for establishing baseline skin tone and identifying subtle changes. Additionally, the handbook emphasises the importance of using more senses in assessments, encouraging practitioners to incorporate touch, sight, and smell to detect infections and other issues.
Emphasising early detection and comprehensive care
A significant portion of the handbook is dedicated to upskilling healthcare professionals on the importance of early detection and comprehensive care. The “visual guide” section is particularly noteworthy, offering images and descriptions of common foot complications like neuropathy, peripheral arterial disease (PAD), and various types of ulcers.
Debbie Sharman, Consultant Podiatrist at Dorset HealthCare University NHS Foundation, highlights the critical nature of early detection: “Delaying help leads to poor outcomes, including amputation. It’s important to identify neuropathy as a risk factor since it can cause problems without pain.”
Conclusion
The “Diabetes Footcare in Dark Skin Tones” handbook is more than just a guide; it’s a call to action for healthcare professionals to adopt more inclusive and effective practices. By focusing on the unique challenges faced by people with dark skin living with diabetes, this handbook ensures that everyone receive the highest standard of care. For those in the medical field, this resource is indispensable in fostering a more equitable healthcare environment
