How Can Podiatrists Address Fear of Diabetes Complications?

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Welcome back to another edition of Podiatry Today's News and Trends column, and this time we're excited to bring you the interview in a video format with Dr. Garnisha Torrence. Dr. Torrence is a clinical researcher at the University of Michigan, Podiatry Service, Chief at the Ann Arbor VA Medical Center, and a clinical Assistant Professor of Internal Medicine in the Division of Metabolism, Endocrinology, and Diabetes at the University of Michigan Medical School Dr. Torrence is fellowship trained in limb preservation moon care and diabetes-related lower extremity complications from the University of Michigan, and now serves as the Director of the Podiatry fellowship, quality, improvement, and Patient Safety program. She also has a Masters in health management systems from Duquesne University, in Pittsburgh, Pennsylvania, and on the national level. She represents the field of podiatry and medicine in general as a member of the American Diabetes Association Scientific Sessions Meeting Planning Committee and the chair of the Foot Care and Lower Extremities Subcommittee. Today Dr. Torrence is with us to discuss a recent article that homes in on mental health and wellness of those dealing with diabetes and its related complications.

A June 2022 article in the Journal of Diabetes Complications took a look at perceptions and fears of four hundred and seventy eight patients with respect to complications of diabetes. Specifically over a quarter of these patients had diabetic foot ulcers, charcoal and neuropathic fractures and dislocations. This sub-cohort much more commonly reported extreme fears of foot infection, major lower extremity, amputation, blindness, dialysis, and death. Both types of amputation and infection were the highest-rated fears among the cohort.

So Dr. Torrence. I'm curious in your practice. What types of fears have patients with diabetic foot complications expressed to you?

Garneisha Torrence, DPM: Um. So perhaps the number one is amputation. But there are several, like infection, because that kind of opens the door for possible surgical intervention, and sometimes with surgery.

But also patients expressed concerns about not being able to walk for long periods, being hospitalized, taking too much time off from work and losing their job and just not being able to care for themselves and having to depend on a caregiver or a family member. That definitely does seem to come up fairly often when they do express these fears to you.

Jennifer Spector, DPM: How have you addressed this in your interactions with patients?

Garneisha Torrence, DPM: The first thing is that I try to provide the clinical environment so that patients feel comfortable talking about their fears. The next thing I try to do is to be supportive as a provider, as a surgeon and an advocate. I let them know that, you know this is a very serious complication, and it's okay to have fears, and I can help them get through it. As a podiatrist, my job is specialized to deal with a foot concern, but I have knowledge about different services and resources, and I can kind of facilitate the patient getting to those resources so they can get the additional support they need. I think it's important for podiatrists to know about those resources in their area. Like you said, we are the the lower extremity specialists, but that doesn't mean we can't get them hooked into the right services and the right specialists in each of those other areas to help them out.

I actually had a patient of mine whose ulcer progressed to infection, and he had to be non-weight-bearing for a long time. Several weeks. So at first he was kind of reticent about his fears, but eventually he told me that he was afraid that he was going to get an infection. He was very active. He was looking towards retiring soon, and then he thought that this will impede his retirement. He wouldn't be able to work. He will lose his job. He'll be dependent on his wife for the rest of his life. And so I place the social work referral to kind of help him so to assist him with coping with his concern, and I actually wrote a letter to his employer, just asking if they could modify his work schedule, so that he can like work from home a little bit, and maybe do more of an office job while he healed his ulcer. And so, with the proper strategies to adjust his fears, he was able to focus more on, like what I was saying my instructions, and to do what he needed to do to heal. And he had a positive outcome, and he was able to, you know, get to his son's wedding without an ulcer. And so he had a a very positive outcome.

Jennifer Spector, DPM: How do you feel podiatrists can take this information from this study and apply it in their current practices?

Garneisha Torrence: Well, I um really enjoyed the the study. There's a lot of information, I think the number one thing is that first podiatrists need to recognize that parents patients have fears about their diabetes-related foot complications, and that these fears may rank high and they can rate higher than death for some patients, and so we have to get in that mindset that you know infection and amputation are very serious to patients, and they may not realize that  death may be around a corner. But I'm tailoring the conversation to infection and amputation can greatly improve the outcomes for these to patients, and that patients may be embarrassed to discuss their fears. So sometimes as a podiatrist, you have to ask, "What fears do you have related to your foot concern," and once those fears are known, we as providers, can educate the patient appropriately and pull in other support services and collaborative teams as needed.

Jennifer Spector, DPM: Is there anything else that you'd like to add on this particular topic?

Garneisha Torrence: So i'm just happy that there's more of a focus on these psychosocial concerns that patients have, because it is very real. And I think, the more that all providers who have to deal with diabetes foot complications are aware of them. The more we can help treat our patients better.

Jennifer Spector: Absolutely, and I hope that readers of Podiatry Today and and those tuning into this edition of News and Trends will share their experiences on social media and online at podiatry today.com. Thank you so much, Dr. Torrence, for joining us today, and we look forward to speaking with you more in the future.