Doireann putting her best foot forward in Rapid Access Clinic

In our third installment of our ‘Day in the Life’ series, Dan Danaher speaks with local podiatrist Doireann MacLaughlin.

WHILE a lot of health services were put on hold due to the Covid-19 pandemic, local podiatrists decided they could continue providing an accessible service to reduce the number of patients attending University Hospital Limerick.
This prompted the establishment of two Rapid Access Clinics in Ennis and Limerick in April 2020.
Doireann MacLaughlin, who works with podiatrist, Jacqueline Hartigan in Ennis stressed patients who attend a podiatry clinic deserve the best possible care. Up to 60 appointments are completed for patients in each clinic every week.
“We have the most fantastic team in Ennis and great administrative support. To heal a patient you must look at blood flow, infection and pressure. We link in with general practitioners to ensure antibiotics are not overused. Pressure overloading is one of the most important things to heal an ulcer. Patients were told to rest and stop putting pressure on their foot.
“Studies show if you offload someone with a foot problem with special shoes, you will heal them faster.
“Instead of people staying at home with a foot ulcer they started coming into the clinic sooner.
“We were seeing people who were afraid to go to hospital for a procedure. If someone came into our clinic and they were acutely unwell, they were sent to ED. We still followed all the clinical guidelines,” she said.
She explained that allocating Sláintecare funding to address the overloading issue made a big difference for patients.
The success of the Rapid Access Clinics has been featured in a webinar that was broadcast nationally to an audience that included representatives from the Department of Health last October.
This prompted the establishment of a monthly webinar series and the latest one concerned the management of the diabetic foot with input from a variety of health professionals in the region and a specialist footwear company.
The Salthill native graduated from podiatry in NUIG in 2012, moved down to Clare to work in the clinic in April 2013, transferred to work in University Hospital Limerick for about 18 months in 2015, moved to set up a foot service in Limerick and returned to the clinic in 2017.
Her job involves working in a team that provides a service for people who are at high risk of developing foot problems.
This primarily concerns diabetes patients who can lose blood flow and feeling in their feet. If a patient loses one of these or the two, they may have a wound on their foot that can lead to an amputation or a chronic developing wound.
She tries to engage in preventative medicine to reduce the risk of an ulcer by detecting patients earlier.
Podiatrists work very closely with their nursing colleagues in community care to identify patients with leg wounds. She lamented the loss of their “fantastic” podiatry manager, Carmel Devine, who retired earlier this year.
While Ms MacLaughlin was working the Limerick podiatry service she recalled a pilot project showed that by taking a group of people off waiting list and providing podiatry this saved in the region of 85% of the cost of what they had been put on the list for. She said podiatrists have a very good knowledge of orthotics and footwear.
Approval for in the region of €170,000 in Sláintecare funding secured another dedicated podiatry post, administrative and stock that could be adapted.
With the help of physiotherapists and other professionals, the team dramatically reduced waiting times to achieve a scenario where 80% of patients who came into the clinic received an appraisal or were fitted with specialist footwear.
For diabetes patients, she pointed out 15 to 25% of them are likely to develop a foot ulcer. In 2020, the International Diabetes Federation reported amputation for diabetes patients is ten to twenty times more common compared to those without this condition.
It is estimated that every 30 seconds a lower limb or part of a lower limb is lost somewhere in the world as a result of diabetes. If a person with a foot ulcer has a bone exposed, she explained a person could end up losing part of their foot, depending on their blood flow. Foot ulcers can also be very painful. She recalled the clinic has saved numerous toes and limbs over the past year because of early intervention.
Jim Enright (68), who lives near Doora Church, praised the excellent care he received in the Ennis podiatry clinic. Mr Enright recalled he caused a lot of damage to his big toes in his right and left leg when he placed a hot water bottle on his feet in bed and fell asleep before removing the bottle.
At the start of the pandemic, he was treated in University Hospital Galway and was referred to the podiatry clinic in Ennis.
“I have been attending the clinic for the last 15 months and there is progress on a daily basis. I found the team excellent in terms of management, punctuality and overall achievement. It is important to carry out the instructions from the podiatrists. The team in UHG have given the Ennis clinic the highest appraisal after reviewing my feet.”

By Dan Danaher