How Can Creative Solutions, Leadership, and Teamwork Prevent Diabetic Foot Complications?

The burden of diabetic foot ulcers (DFUs) is alarming. Approximately 34% of people with diabetes will develop a foot ulcer in their lifetime, and 85% of diabetes-related lower-leg amputations are preceded by a foot ulcer.¹ The 5-year mortality rate for patients with a DFU approaches 40%, climbing to 63% for those undergoing amputation. 

Rural communities, however, are disproportionately affected. One study found that 84.5% of patients with diabetes lived in rural regions had this same cohort had a 16% prevalence of foot ulcers, with risk factors such as illiteracy (69%), smoking (21.5%), and alcohol use (40%) contributing.² Limited access to specialized care, exacerbated by healthcare disparities, can fuel these devastating outcomes.

The Multidisciplinary Team: Proven Success, Ongoing Need

Multidisciplinary teams (MDTs) offer a proven path forward. A systematic review found that 94% of the included studies reported reduced major amputations after implementing MDTs.³ These teams may combine expertise in fields including medicine, podiatry, vascular surgery, orthopedics, interventional radiology, nursing, and physical therapy. Their coordinated efforts focus on dimensions such as glycemic control, wound management, vascular health, and infection prevention.

Despite the success of MDTs, achieving the desired reduction in amputation rates remains elusive. However, healthcare systems implementing MDT programs have seen amputation reductions between 39% and 56%, underscoring the need for continued investment.³

Bridging the Gap: Innovative Interventions

Just as with the concept of a multidisciplinary team, the approach to DFUs and amputation prevention as a whole requires innovative thinking and multiple layers of intervention. Expanding community health programs, mobile clinics, and telemedicine services can bridge critical gaps in diabetic foot care, particularly in underserved areas.^4,5

• Preventive Foot Care: Regular foot checks, both self-administered and by healthcare providers, are key. Podiatrists are especially aware that early detection can prevent severe complications.
• Education and Support: Diabetes Self-Management Education and Support (DSMES) programs empower individuals to better control blood sugar and prevent complications. Podiatrists have the opportunity to be a vital referral source for such programs and hopefully positively impact outcomes.
• Mobile Clinics and Telemedicine: Mobile units and virtual care models extend foot care to rural or otherwise underserved communities, potentially reducing delays in diagnosis and treatment.

The Intended Outcomes: Reducing Amputation Rates and Saving Lives

Evidence strongly supports these interventions. A meta-analysis found that telemedicine interventions significantly reduced amputation rates (risk ratio = 0.64) and improved diabetes management indicators like fasting blood glucose and A_1C levels.⁶ Nurse-led telehealth educational programs have also improved diabetes knowledge and self-care behaviors.⁷

Community-based programs have been emphasized by the World Health Organization (WHO) as essential to strengthening healthcare systems for people with diabetes, especially in low- and middle-income countries where 80% of the 
diabetic foot population resides.⁸

Failure to act carries profound risks. Limited access to care can lead to delayed diagnosis and treatment, worsening foot ulcers, and increasing infection, complications, and amputations. Research shows that DFUs double the risk of all-cause mortality compared to diabetes patients without foot ulcers.⁹ Patients developing DFUs have an average 3–5 year lower life expectancy.

Creativity, Leadership, and Teamwork: The Pillars of Progress

Addressing diabetic foot complications requires creativity and thinking beyond traditional models. Mobile clinics, telehealth, and education initiatives reflect how innovation can transform outcomes. Podiatrists are uniquely positioned to become leaders in this way of thinking.

Such leadership is crucial in identifying barriers and guiding MDTs toward solutions. Strong leadership improves satisfaction among patients and team members, ultimately enhancing care delivery.¹⁰ A patient-centered approach with an eye towards early intervention and prevention opportunities could have a significant impact. Just as limb preservation efforts should not end at ulcer healing, they should not begin with the onset of the ulcer. Instead, concerted efforts should begin well before there is evidence of a DFU. 

Teamwork among multidisciplinary providers supports this type of comprehensive, patient-centered care. By combining expertise from multiple disciplines, MDTs can prevent foot ulcers, detect complications early, and intervene effectively, improving quality of life and reducing preventable amputations.³

In short, creative thinking, leadership, and teamwork are indispensable tools to fight the ongoing crisis of diabetic foot disease. Together, they offer a renewed hope for a healthier future for at-risk patients.

In Conclusion

Tackling diabetic foot ulcers and preventing lower limb amputations requires more than tradition—it demands innovation, decisive leadership, and multidisciplinary teamwork. We can expand access to care through mobile clinics, telemedicine, community outreach, and robust education efforts, particularly in rural and underserved areas. By uniting diverse expertise under strong leadership and applying creative, patient-centered strategies, we can dramatically reduce preventable suffering, preserve limbs, and save lives. 

Dr. Archer is a board-certified podiatrist and certified wound specialist who specializes in diabetic foot care, wound management, and limb preservation. She currently practices at the University of Rochester Medical Center’s Department of Orthopaedics and Physical Performance and is passionate about improving access to care in underserved communities.

Published in partnership with the American Society of Podiatric Surgeons

References

1.    Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376(24):2367-2375.
2.    Chavan MS. Prevalence and risk factors of diabetic foot ulcer at a tertiary care hospital among diabetic patients. Int J Adv Med. 2018;5(5):1274. doi:10.18203/2349-3933.ijam20183907.
3.    Musuuza J, Sutherland BL, Kurter S, et al. A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers. J Vasc Surg. 2020;71(4):1433-1446.e3. doi:10.1016/j.jvs.2019.08.173.
4.    Swaminathan N, Wireko AA, Bharadwaj RH, et al. Early intervention and care for diabetic foot ulcers in low and middle-income countries: addressing challenges and exploring future strategies. Health Sci Rep. 2024;7(5):e2075.
5.    Centers for Disease Control and Prevention. About Diabetes Self-Management Education and Support. https://www.cdc.gov/diabetes/managing/education.html. Accessed October 14, 2025.
6.    Wu X, Guo J, Kang H, et al. Effectiveness of telemedicine interventions for diabetic foot ulcer: A meta-analysis. Adv Wound Care (New Rochelle). 2021;10(8):451-462.
7.    JMIR Nursing. Nurse-led telehealth program improves diabetes foot care knowledge. JMIR Nurs. 2022;5(1):e31567.
8.    World Health Organization. Global Report on Diabetes. Geneva: WHO; 2016.
9.    Harding JL, Andes LJ, Rolka DB, et al. National and state-level trends in nontraumatic lower extremity amputation among U.S. Medicare beneficiaries with diabetes, 2000-2017. Diabetes Care. 2020;43(10):2453-2459.
10.    American Nurse. Leadership strategies to enhance interdisciplinary team success. Am Nurse. 2021;53(5):8-10.