The worldwide implementation of the ‘Train the Foot Trainer’ programme

It is shameful that a lower limb is amputated every 20 seconds across the world, considering that most of these could be avoided by fairly simple interventions, supported by fundamental diabetic foot education. However, the training of healthcare professionals to deliver simple, but effective, diabetic foot care is sadly lacking in many parts of the world. The International Working Group on the Diabetic Foot recognised this in 2003 when the Step by Step (SbS) training course was developed and introduced 1 year later in two pilot countries. To address manpower and resource limitations in some countries, the Train the Foot Trainer (TfFT) programme was developed and training teams were implemented across not just countries, but whole regions. This course is not a training course to teach skills and knowledge about diabetes foot disease, it is a programme that teaches course structure, teaching methods, evaluation skills, data collection, strategic organisation/development, networking structures and optimising available resources. Furthermore, it is a course run for experts to train others to become experts in clinical and educational skills and knowledge. This article offers a brief account of this innovative and successful implementation initiative.