Maintaining healthy skin on the lower limb is crucial in preventing a range of complications, particularly for individuals with conditions that increase the risk of skin injuries, such as diabetes or skin conditions. Podiatrists, as specialists in the foot and ankle, play a vital role in early identification and prevention of lower limb skin injuries.

Historically, there has been some debate – or a lack of clear understanding – over where ‘responsibility’ lies for issues relating to the lower limb. Definitions of where the lower limb ends and the foot begins may vary and cause confusion over the role of different clinicians in prevention and management.

As such, a multidisciplinary group of experts met online on 30th May 2024 to discuss the role of the podiatrist and how their expertise can benefit patients who are at risk of all types of lower limb skin damage (not only the foot). This document reflects the discussion of the experts and how the findings can be applied to practice.

This document aims to:

Clarify definitions of the lower limb, the foot and related terminology
Identify risk factors common for both lower limb and foot-related changes
Encourage effective communication and a multidisciplinary team (MDT) approach to promote early identification and continuity of care for patients
Explore ways in which prevention and early identification of lower limb changes can be optimised as part of the existing practice of podiatrists
Increase awareness and confidence for all clinicians involved with the foot and lower limb to deal with issues promptly as they arise and know who to speak to for further advice or if a referral is needed.

Podiatrists have a wide range of skills such as assessing skin and musculoskeletal (MSK) conditions, identifying risk factors, and implementing targeted interventions, which are instrumental in mitigating the risk of developing an issue with the foot and associated complications. Through regular comprehensive foot examinations, podiatrists can detect early signs of skin damage, such as calluses, blisters, or areas of increased pressure, and promptly address these issues before they progress to more serious ulcerations.

This in turn means podiatrists may also be ideally placed to be more involved in the prevention and early identification of skin damage affecting the lower leg (as opposed to the foot), such as venous hypertension, skin tears, oedema and venous leg ulcers (VLUs), to reduce patients’ cumulative risk of such injuries and their associated complications if left untreated.

The growing prevalence of chronic wounds, such as DFUs and VLUs, and the significant strain placed on healthcare services, necessitate the need for the early identification and prevention of lower leg injuries, with a clear MDT approach wherever possible so that early signs are not missed.

Karen Ousey, Chair

Download the full consensus document below

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This document has been developed by The Diabetic Foot Journal and supported by Biocomposites, Essity and L&R.

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