Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

Background - Patient Education and Foot DiseaseAn integral part of any strategy to reduce diabetes foot problems requires people withdiabetes to have adequate knowledge to be able to take appropriate action to minimisetheir risk of developing foot complications (Levin, 1995). Deficiencies in self care offeet can occur because people with diabetes have received inadequate information orare not aware of the importance of, or are unable to perform, foot self care behaviour.One study showed that 89% of people with diabetes whose feet are at increased riskwere making multiple errors in their foot self care behaviour (Plummer & Albert,1995). Unfortunately the healthcare system does not currently provide easilyaccessible education or podiatry services for people with diabetes whose feet are “atrisk” (Fletton et al, 1995). Those who are physically unable to practice self footcaredue to age or a disability, like visual impairment, are often dependent on family orcarers who must also be involved in the educational process. Also people with a lowersocio-economic status have increased risk of foot ulceration and poorly fitting (or lackof) footwear (Day & Harkless, 1997).The extent and nature of the education necessary to prevent the development ofdiabetic foot problems and the means of selecting an appropriate educational strategyfor each person is another important consideration. There is a general lack ofconsistency of educational interventions which have used different methods, targetgroups, settings and methods of follow-up which has complicated interpretation ofeducational studies (Mason et al, 1999).Even the most successful published footcare education programmes have not alwayscontinued to be used in the institutions where they were developed (Pichert & Penha,1993). Footcare education programmes should be coordinated and not provideeducation to people with diabetes but staff should also receive education andprompting to perform routine footcare tasks.Evidence - Patient Education and Foot DiseaseFootcare education for people with diabetes improves knowledge and mayimprove self care behaviourValk et al (2002) conducted a Cochrane systematic review through searchingMedline, CINAHL and EMBASE, hand searching of wound care journals andrelevant conference proceedings and identified 8 prospective randomised controlledtrials which evaluated educational programmes for the prevention of foot ulcers inpeople with Type 1 or 2 diabetes. Four RCTs comparing intensive with briefeducational interventions were identified (Barth et al, 1991; Kruger et al, 1992;Ronnemaa et al, 1997; Malone et al, 1989). All four were performed in an outpatientcare setting. Patients' knowledge of foot care was reported in 3 of the 4 RCTs (Barthet al, 1991; Kruger et al, 1992; Ronnemaa et al, 1997). This outcome was significantlyimproved in 2 of the RCTs, at 6 months in one (Barth et al, 1991) and at 1 year in theother (Ronnemaa et al, 1997). In one RCT, foot care knowledge was not improved inthe intervention group at 6 months follow up (Kruger et al, 1992). However, this RCTstudied small groups (23 patients in the intervention group and 27 in the controlgroup), and also had a relatively high dropout rate.59