A step in the right direction

A roving podiatrist is improving foot health in Indigenous communities in Central Australia by delivering podiatry and foot-care education services.

For 26 weeks a year, podiatrist Sara Coombes, and her husband and podiatry assistant Tim, tour 14 Central Australian communities treating foot ailments associated with chronic disease. By providing foot care and education, Sara and Tim are reducing the risk of infection, complications and amputation amongst Indigenous patients in remote communities.

Since 2014, the number of remote Indigenous patients receiving treatment from Sara has grown by 167 per cent. Sara estimates that the number of people with diabetes having at least one foot check per year has increased from less than 15 per cent in most communities when she first visited in 2009, to up to 90 per cent today in these communities.

Through frequent and targeted treatment for diabetic patients, Sara and Tim are taking a preventative approach to minimise the risk of infection and amputation from diabetic foot.

“Prevention is the only way we are going to reduce the amputation rate, so preventive treatment needs to start early and to be repeated to prevent damage,” Sara said.

Sara and Tim educate their patients on simple foot care. They conduct one-on-one demonstrations and discussions on scrubbing feet, removing cracked and dry skin, the importance of footwear, and cutting nails.

“Simple foot care is one of the major reasons that diabetic patients don’t end up with amputations. Even when you have really poor circulation, if you can keep the skin intact, you can keep the foot healthy,” said Sara.

But even simple foot care can be challenging in some remote areas where patients have limited access to quality footwear. A lack of high-quality shoes that can be fitted with orthotics has led Sara to develop what she calls, ‘Thongthotics.’ To treat or prevent foot ulcers, sore heals, aching tendons and more, Sara alleviates pressure by hand-cutting and sticking layers of felt onto a patient’s thongs.

Sara relies on her relationships within each community to engage patients and share knowledge with local health service providers. The arrival of Sara and Tim’s caravan is the cue for most patients to visit the podiatrist team, and Tim actively seeks others out to encourage them to visit the clinic. This personalised and targeted approach has helped to build rapport with each patient and trust within the community.

“In one community, two young girls who initially were very nervous to see me are now the first ones in when the clinic opens. They’re doing really well with their feet and now bring older community members to receive treatment too,” Sara said.

Sara also shares her knowledge with local health professionals. During each community visit, she aims to teach local health service providers one key piece of information surrounding foot health. From trimming toenails to learning which dressings are best suited to foot wounds, improving and maintaining foot health has become daily practice for health practitioners and patients alike. Local nurses play an essential role by maintaining a patient’s feet in between Sara’s visits, and provide dressings and debridement for wounds and ulcers.

Sara explained, “I had a desire for a long time to do something in Indigenous health. I love it, I love the people and find it really rewarding. It’s just so nice to see things changing – albeit only slowly. My clients now tell me about keeping skin healthy and intact as opposed to asking in the initial visits why we were washing their feet. And that’s a great outcome.”

Sara is funded under Northern Territory PHN’s Medical Outreach Indigenous Chronic Disease Program. Under the program, she and other allied health professionals – including an exercise physiologist, physiotherapist, dietician, speech pathologist and occupational therapist – provide remote outreach services to over 80 Indigenous communities across the Northern Territory. Together, they’re working to prevent, detect, treat and manage chronic conditions amongst Indigenous Australians.

For more information on the Medical Outreach Indigenous Chronic Disease Program, visit ntphn.org.au/our-programs