Prevention and Early Intervention for Diabetes Foot Problems
The staggering human and economic costs of diabetes foot
disease may be reduced significantly with increased practice of several simple
preventive care measures designed to prevent foot ulcers and lower extremity
amputations. Routine annual foot screening facilitates early interventions to
reduce the incidence of the most common precipitating events including injury
and footwear-related trauma to the insensitive foot. The key elements of
preventive care include: annual examination of the feet by health care
providers to determine risk factors for ulceration; subsequent exams of high
risk feet at each patient visit; patient education about daily self-care of the
feet; and careful glucose management. The national health objectives for
the year 2000 to decrease the rate of amputation in the population overall, as
well as in specific high risk minority groups, serve as a call to action for
both health care providers and people with diabetes to make routine diabetes
foot care a high priority.
1. U.S. Department of Health and Human
Services: Healthy People 2000. In National Health Promotion and Disease
Prevention Objectives. Washington, D.C., U.S. Govt. Printing Office, 1991 (DHHS
pub. No. PHS 91-50212).
2. Kenny SJ, Smith PJ, Goldschmid MG, Newman JM, Herman WH: Survey of
physician practice behaviors related to diabetes mellitus in the U.S. Physician
adherence to consensus recommendations. Diabetes Care 16(11):1507-1510,
3. Reiber GE, Boyko EJ, Smith DG: Lower extremity foot ulcers and
amputations in diabetes. In Diabetes in America. 2nd ed., National
Institutes of Health, NIDDK, NIH Pub. No. 95-1468, 1995.
4. Lavery LA, Ashry HR, van Houtum W, Pugh JA, Harkless LB, Basu S:
Variation in the incidence and proportion of diabetes-related amputations in
minorities. Diabetes Care 19(1):48- 52, 1996.
5. Lavery L, et al: Lower extremity amputations in San Antonio,
Texas. Abstract, 2nd International Foot Conference, Netherlands, 1995.
6. Nelson RG, Ghodes DM, Everhart JE, Hartner JA, Zwemer FL, Pettitt
DJ, Knowler WC: Lower-extremity amputations in NIDDM: 12-year follow-up study
in Pima Indians. Diabetes Care 11:8-16, 1988.
7. Mayfield JA, Rith-Najarian SJ, Acton KJ, Schraer CD, Stahn RM,
Johnson MH, Gohdes DM: Assessment of diabetes care by medical record review.
The Indian Health Service model. Diabetes Care 17(8):918-923, 1994.
8. Palumbo PJ, Melton LJ: Peripheral vascular disease in diabetes. In
Diabetes in America. Harris MI, Hamman RF, Eds. Bethesda, Md., National
Diabetes Data Group, NIH Pub. No. 85-1468, 1985, p.1-21.
9. Levin ME, O'Neal, Bowker JH: Preface. In The Diabetic Foot (5th
ed.). Levin ME, O'Neal, Bowker JH, Eds. St. Louis, Mosby-Year Book, 1993, p.
10. del Aguila MA, Reiber GE, Koepsell TD: How does provider and
patient awareness of high- risk status for lower extremity amputation influence
foot-care practice? Diabetes Care 17(9):1050-1054, 1994.