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Prevention and Early Intervention for Diabetes Foot Problems

5. Provider and Patient Education

Education Reduces Lower Extremity Abnormalities

In a randomized, controlled study, researchers provided intervention patients with foot care education, behavioral contracts, and telephone and postcard prompts. The researchers placed foot care prompts on the medical record, and provided practice guidelines and flow sheets to clinicians assigned to those patients. Results showed that primary care physicians in the intervention group conducted more examinations of lower extremities, identified those at risk for amputation, and referred more patients for podiatric care. Patients in the intervention group received more patient education, made more changes in appropriate self-care behaviors, and had fewer short-term foot problems than patients in the control group21.

The Components of Good Patient Education

Findings from several studies help determine effective components of patient education that contribute to successful patient outcomes. These include giving detailed foot care recommendations, requesting patient commitment to self-care, demonstrating and practicing foot care procedures, and communicating a persistent message that foot complications can be avoided by self-care. In comparing the effectiveness of intensive versus conventional education, researchers found that patients in the intensive group showed greater improvement in foot care knowledge, better compliance with the recommended foot care routine, and greater reduction in the number of foot problems requiring treatment22.

Foot care recommendations and demonstrations should include: washing, drying, and inspecting the feet; cutting toenails; treating minor foot problems; selecting suitable footwear; dealing with temperature extremes; and contacting the physician if problems do not resolve quickly. Patients with high-risk feet should inspect them twice a day. Those with peripheral neuropathy, vascular disease, or eye disease should not attempt to cut their own toe nails as this can lead to serious self-inflicted injury. It is important for the provider or diabetes educator to review with the patient all written take-home instructions for self-care of the feet20.

Researchers found that the frequency of desired self-care behaviors improved when patients were given specific instructions such as "dry between toes" and "file calluses" rather than more general instructions such as "avoid injury to your feet." To be more effective, the investigators recommended that instructions should be stated as precisely as possible such as "don't go barefoot indoors21."

Patients should never be allowed to walk on open plantar ulcers since continuous application of mechanical load will prevent healing. Walking aids, footwear modifications, or other interventions must be used to relieve weight23.

A pilot program for African Americans consisted of a 15-minute orientation meeting between a diabetes nurse educator and the person with diabetes, a take-home foot self-care packet, and a follow-up telephone interview. During the telephone interviews, subjects reported that the most useful parts of the take-home packet were the patient instruction booklet, the large hand mirror included in the packet, and the foot care knowledge self-test with explanations of the answers. Subjects also valued the reminder cue that was repeated in bold face on each page of the booklet telling them to call the doctor immediately if any cut, bruise, or blister does not begin to heal after one day24.

Step-by-step guidelines have been published to assist providers to conduct patient education workshops on foot care including how to attract participants, promote the workshop, develop the agenda, identify appropriate speakers, and conduct a post-workshop evaluation25.

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WebMD Public Information from the U.S. National Institutes of Health

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