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    Feet Can Last a Lifetime

    Introduction

    National Hospital Discharge Survey data for 1994 indicate that 67,000 people with diabetes underwent one or more lower-extremity amputations. Diabetes is the leading cause of amputation of the lower limbs. Yet it is clear that as many as half of these amputations might be prevented through simple but effective foot care practices. The 1993 landmark study, the Diabetes Control and Complications Trial funded by the National Institute of Diabetes and Digestive and Kidney Diseases, conclusively showed that keeping blood glucose as close to normal as possible significantly slows the onset and progression of nerve and vascular complications associated with diabetes.

    People with diabetes are vulnerable to nerve and vascular damage that can result in loss of protective sensation in the feet, poor circulation, and poor healing of foot ulcers. All of these conditions contribute to the high amputation rate in people with diabetes. The absence of nerve and vascular symptoms, however, does not mean that a patient's feet are not at risk. Risk of ulceration cannot be assessed without careful examination of the patient's bare feet.

    Early identification of foot problems and early intervention to prevent problems from worsening can avert many amputations. Good foot care, therefore, is an essential part of diabetes management -- for patients as well as for health care providers.

    This kit is designed for primary care and other health care providers who counsel people with diabetes about preventive health care practices, particularly foot care. "Feet Can Last a Lifetime" is designed to help you implement four basic steps for preventive foot care in your primary care practice.

    1. Early identification of high risk feet.

    2. Early diagnosis of foot problems.

    3. Early intervention to prevent further deterioration that may lead to amputation.

    4. Patient education for proper footwear and care of the feet.

    The kit includes the tools you need to identify and diagnose diabetes foot problems, to develop a management plan, and to educate your patients.

    • A foot screening form and instructions.
    • Prescription forms to facilitate Medicare coverage of therapeutic footwear.
    • A review of current research.
    • A list of additional resources.
    • Patient education materials.

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