Abstract
Dear Editor:
Palliative wound care, an underappreciated form of palliative care, is an evolving multidisciplinary subspecialty that continues to grow as people continue to live longer and the geriatric population grows at a disproportionate rate; however, in the current palliative care literature, the composition of a palliative wound care team is rarely discussed. More specifically, the inclusion of podiatrists on palliative wound care consult teams is nonexistent, despite the podiatric community being at the forefront of wound care advancement. Podiatric medical education is well rooted in wound care management and education in an effort to maximize outcomes in diabetic and elderly populations and contribute to existing multidisciplinary teams. In addition, many podiatrists choose to pursue fellowships that focus on wound care and limb salvage/reconstruction, which further exposes fellows to advanced pain management, preventative measures, and research efforts.
It is the belief of the authors that podiatrists, specialists of the lower extremity, can have the largest contribution to the current palliative care model through the utilization of podiatric wound care knowledge for treatment of pressure or decubitus ulcers, a problem that disproportionally plagues palliative patients. 1 Pressure ulcers in the foot and ankle region account for roughly 29% of all deep tissue injuries and 41% of deep tissue injury in the heel of bedridden and dying patients.2,3 The integration of podiatrists to any consult team may be of benefit to any palliative wound care team. According to a study conducted in 2003, 74 end-of-life patients had ulcers for an average of 47 days out of the 180 days they were surveyed. 4 With patients spending roughly 25% of their end-of-life experience living with painful pressure ulcers in the foot and ankle region, it is clear that more can be done to help these afflicted populations. 4 Above all, proper management of lower extremity wounds is imperative. Sores and ulcers can be painful, debilitating, and certainly impact the quality of life (QOL), and the improper management of pathology may be even more destructive by causing patient discomfort and anxiety. 5
In the case of palliative wound care of the lower extremity, a podiatric consult for more complex wounds can place podiatrists in a prime position to provide specialized care to dying patients, help families, and enhance the efforts of primary palliative care teams, which could lead to the maximization of outcomes in terms of QOL and end-of-life experiences. Access to adequate podiatric wound care is essential to ensure optimal end-of-life care in the palliative setting. Wound care on any aspect of the body is a common and complex issue that negatively impacts patients and families and can necessitate the involvement of the proper specialists in an effort to prevent the risk of adverse outcomes. As palliative medicine continues to evolve in the assessment and management of the needs of palliative patients, the inclusion of proper health professionals to the current consult model, such as podiatrists, can better address these common and complex issues and further optimize outcomes while reducing patient and financial burden.