Elizabeth Ruth Choudhry: "COVID-19 changed my daily foot practice"

Whether we are working in our clinics or driving home after a long day at work, it is a little comforting to know that we are not alone in facing the current health crisis. 

As the whole world tackles the pandemic of COVID-19 and all that it brings, we each face dilemmas and have to make un-precedented decisions every day, about the care of our patients, our colleagues and our loved ones. 

The pandemic statistics are showing us that our diabetic patients are at increased risk of morbidity and mortality from COVID-19 and so, the decisions we make could affect their future wellbeing. 

When seeing a patient, I always reflect on the needs of the patient, the frequency of their visits to my clinic, their juggling other medical appointments etc. but at this time, it has never been more important than to think about the risk we are putting them under by asking them to leave their homes to attend our hospitals and clinics. 

Unfortunately, the disease of diabetes does not go away, and even though we are tackling the challenges of COVID-19, we also have our existing and new patients, presenting with active diabetic foot disease that requires our urgent attention. In clinical practice, I have found it hugely beneficial to use the D-Foot International guidelines on COVID-19 and diabetic foot disease. It has helped me triage each of my patients to determine those that really need to come into the clinic; those that require admission, or those that can stay at home and be followed with regular telemedicine. Being able to prioritise our workload, is essential to ensuring we are there to provide the care we can, to those that need it most. Yes, we will continue to worry about some of our regular patients, but we must accept that we are not living in normal times, and we have to do the best we can under the current circumstances and restrictions. Patients too, require counselling about self-care and the importance of maintaining good glycaemic control, taking their medications regularly and undertaking their own wound dressings if required. I have been heartened to see family members rise to this challenge, and take an active interest in wound care and improving the diabetes management of their relatives.

Sadly, the current situation has also kept many people away from the hospitals, due to fear of contracting the virus, delaying them seeking medical attention when they do have a problem. We are finding an increased number of patients presenting with significant limb-threatening conditions including spreading sepsis, extensive osteomyelitis and gangrene. These patients then require urgent surgery, but first must be tested for COVID-19 virus.

As hospitals become full, cancellation of elective surgeries and outpatient appointments, our diabetic foot patients have less choice on where they can go to receive care and treatment. If they are admitted and have to undergo surgery, there is then the added pressure of discharging them early, to free up hospital beds. We have a duty of care, to ensure that we continue to provide care for these patients on an outpatient basis, or we have resources that we can call upon such as community clinics or other health care facilities that we can refer patients too, for ongoing wound care and management of their other co-morbidities. We must not forget that our patients are a very vulnerable group and if we are struggling to provide these services, we must make managers and health care decision-makers aware of the risk to life and limb if we forget them.

Stay safe everyone, and keep doing the amazing work you do, each and every day.


Elizabeth Ruth Choudhry is Senior Podiatrist, Sheikh Shakhbout Medical City, Abu Dhabi.

After over 20 years working as a podiatrist in the NHS in the UK, came a telephone call asking me to go and work in Abu Dhabi, United Arab Emirates. Having never visited the country before, I set off to see how my skills could help improve the foot health of the population there. 

I didn’t know what to expect of the healthcare system, what resources were available or the types of people that would need my clinical expertise. I just knew that there was a high prevalence of diabetes and I was joining a busy vascular team who spent much of their time, treating patients with diabetic foot disease. 

Six years later, I am still here and loving the challenge of my work, every day. Within the Middle East region, podiatry is not well known, and it took time to raise awareness of the profession amongst the public and also amongst fellow health care professionals.  As the years have passed, my caseload has grown exponentially and now the service treats thousands of people with all kinds of foot problems every year. The primary problem I treat is diabetic foot ulceration, often combined with diabetic nephropathy and end-stage renal disease, multi-level peripheral arterial disease including severe intrinsic foot disease and sadly, many patients still present very late.