Background: Belgium’s national Initiative for Quality improvement and Epidemiology in multidisciplinary Diabetic Foot clinics (IQED-Foot, since 2005, including approximately 2000 patients), reveals large variations in diabetic foot care between different multidisciplinary diabetic foot clinics (MDFC). To better understand these, a survey was launched in 2024 aiming to identify the most common barriers to proper diabetic foot care in MDFC in Belgium.

; Methods: Variations were assessed for specific indicators: offloading, revascularisation, and secondary prevention. MDFC were furthermore divided into higher- and lower-scoring compared to their median score for the given indicator. The survey included open-ended questions to explore possible explanations for varying scores. Responses were sorted into reasons for higher and lower scores according to three categories, namely healthcare provider factors, patient factors, and healthcare system factors.

; Results: All 37 Belgian recognised MDFC participated in the barrier survey. Higher-scoring MDFC for offloading reported effective patient education, intensive multidisciplinary collaboration (orthopaedist, podiatrist, shoe technician) and easier access to resources, unlike lower-scoring MDFC reporting limited personnel, patient refusal and reimbursement issues. Similarly, higher-scoring MDFC for revascularisation demonstrated expertise, strong commitment from the vascular department, and adequate resources, while lower-scoring MDFC addressed limited trained personnel, patient characteristics (i.e., fragile, ill), and low collaboration. Finally, it was again highlighted that patient education and strong commitment from the orthopaedics department, resulted in a high score regarding secondary prevention. Limited trained personnel, patient characteristics and low collaboration were additionally reported for lower-scoring MDFC in terms of secondary prevention.

; Conclusion: Patient education and intensive multidisciplinary collaboration were mostly emphasised in higher-scoring MDFC, while limited suitable personnel, less collaboration and patient characteristics were mainly addressed in the lower-scoring MDFC. A next step is to explore ways to overcome the identified barriers, and to ultimately reduce the variation between different MDFC in Belgium.