Getting DOWN with Amputations in the Commonwealth of the Northern Mariana Islands

Objective:To illustrate the effectiveness of a foot care program in reducing diabetes-related lower-extremity amputations (LEA) in the Northern Mariana Islands (NMI) and provide a model for foot care throughout the Pacific Basin.

Methods:In response to a rise in LEA in 2004, the physical therapy department at Commonwealth Health Center became a primary wound care provider. We used evidence-based resources to educate hospital staff and focused on strengthening working relationships with other healthcare providers. As part of this initiative, we developed a partnership with the Diabetes Prevention and Control Program, who provided us with educational support and funding for development of a multi-disciplinary diabetic foot clinic. This relationship allowed us to increase community education, receive diabetes resources, and purchase wound care materials. To track the impact of these initiatives, we used operating room logs to document all LEA occurring in the NMI from 2001 through 2008.

Results:Our analysis illustrated a rise in LEA until 2004, followed by a dramatic decline after implementation of dedicated foot care. A 48% reduction in total amputations and a 71% reduction in major amputations have occurred from 2004 through 2008.

Conclusion:This study illustrates the importance of community partnerships, multi-disciplinary care, and dedicated providers in a successful foot care program. This will benefit island populations by reducing LEAs through education, skilled wound care, and a multi-disciplinary approach. Knowledge and resources are extremely limited throughout the Pacific Basin, therefore it is essential to utilize resources available and address specific needs in order to be successful.