The ISPO Outreach committee was provided with a grant from the Evert van Ballegooie Stichting (EvB foundation), Netherlands.

The grant was to provide education and training to support high-risk foot management in the Pacific. ISPO used the funding to run an Instructional Course on the Management of High Risk Feet. The course was held in Kiribati, and there were attendees from Kiribati, Samoa and Tonga.


Why was this training needed?

The Pacific island nations make up 8 of the top 10 countries in the world for diabetes prevalence. Diabetic foot complications are among the most common complications of diabetes, and often result in amputation. According to the World Health Organisation, 50% of amputations and hospital admissions as a result of diabetic foot complications can be prevented with appropriate foot care. This instructional course aims to develop the skills of health professionals in the Pacific region to provide appropriate foot care, in order to lower the number of amputations as a result of diabetic foot complications.


What were the aims of the Instructional Course?

– To build sensitivity and awareness of diabetic foot problems and treatment options relevant to the Pacific region.

– To provide education and training on multidisciplinary approaches to the management of diabetic foot ulcers, including wound care, classification, client education and off-loading techniques

– To build relationships and partnerships between clinical care providers within Kiribati and with other participating countries.

– To form the baseline knowledge and skills for the two trainings later in the year, which will be provided by MA as a part of setting up the Diabetic Foot Clinic (DFC) to implement “The Kiribati Amputation Prevention Project”


When and where did the course occur?

Date: 15 – 17th Feb 2017

Location: Tungaru Rehabilition Center (TRS), Kiribati


Who attended the course?

There was a total attendance of 28 participants including nurses from the main hospitals and the community, and the Prosthetist, orthotists and physiotherapists from the TRS Centre.

We were also able to fund the sole podiatrist from Tonga and from Samoa to attend the training. Through the attendance of these podiatrists relationships and partnerships were built between countries. Both podiatrists presented throughout the three days and were able to share their experience of working in with high risk feet in a similar context. Contact details were shared at the conclusion of the course to ensure continued communication between all three countries can continue to occur and knowledge transfer and capacity building can continue to develop.


Who were the presenters?

Andrew Jolly: Prosthetist and Orthotist, Scope Global Volunteer

Katrina McGrath: Clinical Project Officer, Motivation Australia

Phoebe Thomson: Prosthetist and Orthotist, ISPO Co-Chair outreach committee.

Casie Barette: Podiatrist, St Vincent’s Hospital Melbourne

Helene Stehlin: Podiatrist, Samoa


What is the plan to build on this training?

This training was designed in collaboration with Motivation Australia (MA) who will be implementing “The Kiribati Amputation Prevention Project”, which is part of setting up the Diabetic Foot Clinic (DFC) in the Main hospital in Kiribati. This training provided a platform to generate an awareness of diabetic feet, educate nurses, rehab staff and doctors and build an understanding of how the Diabetic Foot Clinic will run. Motivation Australia will run two additional trainings later in the year which will be targeted to specific individuals who will be involved in the Diabetic Foot Clinic.


How was the training content established?

The majority of the content taught in the three days was provided by Motivation Australia’s Keep it Moving Modules. In 2013, Motivation Australia built curriculum to teach a multidisciplinary audience on the principals of diabetic feet, wound management and offloading techniques. This curriculum was broken into 5 modules and was developed to fit the Pacific Island setting. As such the language used, content delivered, and materials and resources discussed were all suitable for this population. All participants received manuals with all Keep Moving Slides as well as assessment forms, prescription forms and follow up forms which will be used in the DFC once it has been implemented.

The first two days saw all participants working together and undergoing theoretical and practical content as a group. A large emphasis of the course was on team-work and the importance of a multidisciplinary approach to health care when treating high risk foot patients. On the final day of the course, participants were split into two groups to enable the content to focus on their areas of speciality. All nursing staff were presented with information on areas specific to their role in the community or in the diabetic foot clinic, whilst all rehab staff and the two International Podiatrists focussed on the practical application of a total contact cast (TCC) which will be their role once the Diabetic Foot Clinic has been implemented.

On the final day of the course, we were invited to present at the Doctors CME Education Session. Katrina McGrath and Helene Stehlin presented their results from the DFC in Samoa and outlined the plans for the DFC in Kiribati. Whilst attendance by the doctors was low, this was an invaluable forum to share the success of the past three days, the success of the DFC in Samoa and to begin to prepare the hospital for the implementation of the DFC in Kiribati. All participants who attended the three day training were presented with two certificates at the closing ceremony; an attendance certificate from ISPO and the EvB Foundation for the completion of the three days of training, and a Motivation Australia Certificate outlining completion of modules 1,2,3,5 and Shoes for Healthy Feet.



Course Schedule

Day 1: The basics

Description: Day 1 focussed on the pathophysiology of diabetic feet, and management of Charcot neuropathy. Both theoretical and practical sessions were used to apply and embed knowledge regarding the assessment, classification and podiatric management including off-loading. Building on assessment methods and explain how these assessment & test results influence clinical decision making & recommendations. The sessions were taught by Casie Barrette; an expert podiatrist from St Vincents Hospital Melbourne, and Andrew Jolly; Posthetist and Orthtoist, who is currently working as a Scope Global Volunteer in Kiribati.


Day 2: Off-loading Diabetic Ulcers

Description: Day 2 aimed to build upon the previous day’s activities, and extend the theory and practical into the use of off-loading methods to treat the diabetic foot. Through combining theory and practical, and hearing from a Samoan Podiatrist, the aim is to facilitate information sharing, discussions and relationship building.


Day 3: Total Contact Casting

Description: Day 3 split the participants into two groups to enable them to focus on their areas of speciality. All nursing staff were presented with information on basic wound care, infection, dressings, debridement and other complicated topical pathologies they may encounter. Whilst all rehab staff and the two International Podiatrists focussed on the practical application of a total contact cast. The day closed with a short session sharing information about ISPO Australia and ISPO International, about Motivation Australia, the “Kiribati Amputation Prevention Project” and the implementation of the DFC, and also to reflect on the training received and answer feedback forms. A closing ceremony concluded the event and all participants were provided with a certificate of attendance and certificatin of completiong of Keep Moving Modules. Following the closing ceremony Helene Stehlin and Katrina McGrath presented to the Doctors at their CME Education session.


What was the participant feedback?

The majority of participants rated the training as excellent and rated the presenters as excellent. They felt the content of the course was applicable to their workplace and they understand the need of a diabetic foot clinic. The majority of people stated that the most relevant topics to their workplace were wound assessment, off-loading techniques, referral writing, understanding ulcers and wound management, how to check ROM and muscle strength.



All resources required for the three day training were shipped over as excess baggage by Casie Barette and Phoebe Thomson. These resources were invaluable throughout the theoretical and practical sessions. A large amount of resources have been left at the TRS center for staff to continue to practice their skills and to be used once the DFC has been implemented at the end of April/ start of May.

Motivation Australia have procured a shipping container with large numbers of the resources required for the implementation of the DFC. This is due to arrive for the second training session at the end of April/ start of May. All resources ordered by Motivation Australia will complement the resources brought over by ISPO for the first course.


For more information, please contact