Journey from the Step-by-Step Diabetic Foot programme to Train the Foot Healthcare Professionals: 22 years of preventing amputation globally

High rates of morbidity and mortality are associated with diabetes-related foot complications, which are on the rise worldwide. Between 40% and 60% of all lower extremity non-traumatic amputations performed globally are on patients with diabetes. Every 20 seconds, a lower limb is lost to diabetes worldwide, yet the majority of these amputations could have been prevented with simple foot care interventions, regular screening and proper education. Despite this urgent need, healthcare professionals remain insufficiently trained in delivering simple yet effective diabetic foot care, leaving patients vulnerable to avoidable amputations. Amputation rates can be decreased by up to 85% by prophylactic measures, close patient monitoring, multidisciplinary treatment of foot ulcers, and education of healthcare staff on proper foot care. The Step-by-Step (SbS) Diabetic Foot programme, which was piloted and implemented in Tanzania and India in 2003, is an example of education. Crucially, the research was linked to a decrease of more than 50% in amputation rates in Tanzania. Due to the success of the programme, there is a growing demand for the adoption of the SbS programme in other countries. D-Foot International launched the Train the Foot Healthcare Professionals programme to overcome the challenges of reaching every country. The goal was to bring trainers from various nations in the region together and train healthcare professionals to execute SbS programmes when they return to their home countries. This paper provides a concise description of this innovative and successful implementation effort. The 22-year journey began in Tanzania in 2003 and culminated in global healthcare professional training, serving as a working model to reduce amputation and mortality.