New Foot Screening Tool Targets Preventable Diabetes-Related Amputations

A standardised diabetic foot risk assessment tool has been introduced across Montserrat after a review identified 15 diabetes-related amputations over five years.

The findings were presented during the Ministry of Health and Social Services’ Annual Research Day by Rachel Jackson, a community practice educator with Calderdale and Huddersfield NHS Foundation Trust.

Jackson completed a three-month fellowship placement in Montserrat focused on workforce development and community-based care.

Her retrospective review examined hospital admissions between 2020 and 2025. The 15 amputations recorded during the period equated to approximately one amputation for every 293 residents.

Jackson said international evidence suggested that about 85% of diabetes-related amputations could be prevented through early identification and appropriate care.

The project found that Montserrat did not have a standardised screening process or consistent escalation protocol for diabetic foot ulcers. This created the risk of patients receiving different assessments depending on where they entered the health system.

A universal risk stratification tool was therefore developed for use in community clinics and at Glendon Hospital.

The tool uses a traffic-light system to classify a patient’s risk and guide health professionals on when to monitor, treat or escalate a case.

It was launched island-wide on April 24, 2026, alongside staff training and patient education materials.

Following training, staff confidence in escalating diabetic foot concerns increased from an average of 3.1 to 4.12 out of five.

The system is intended to move diabetic foot care from reacting to advanced wounds towards identifying warning signs before they result in serious infections or amputations.

The need for community education was reinforced by an incident shared during Research Day. Acting Director of Primary Health Care Services Penny Maloney said a resident approached her with a discoloured toe but was reluctant to visit a clinic despite recognising that the colour had recently changed.

The incident illustrated the continuing gap between recognising a potentially serious symptom and seeking immediate care.

Researchers recommended ongoing staff training, regular use of the assessment tool, increased patient education and monitoring to determine whether the system reduces amputations over time.