PubMed · 11530572
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K E Jessen. 2001-08-20. [Foot problems].. https://pubmed.ncbi.nlm.nih.gov/11530572/
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In the last year an International Consensus on the Diabetic Foot has been developed by a group of independent experts from all over the world. The definition of the diabetic foot is based on WHO criteria as infection, ulceration and/or destruction of deep tissues associated with neurological abnormalities and various degrees of peripheral vascular disease in the lower limb. It is one of the most serious complications of diabetes: approximately 50% of all non-traumatic amputations are performed on patients with diabetes, it is a frequent cause of hospitalisation and disability of diabetic patients. Comprehensive prevention and therapy of diabetic foot provided by a podiatric team may reduce the number of amputations by 50% and it may decrease substantially the cost of long-lasting therapy. In all countries foot-care management should be organised at the general practitioner and podiatric nurse level and specialised foot centres with a diabetologist, a podiatric nurse, a radiologist, general, orthopaedic and vascular surgeons, an orthopaedic technician and a physiotherapist should be formed. The podiatric team has the following responsibilities--to identify patients at high risk and monitor them and to treat patients with ulcers. Treatment of diabetic foot must include non-weight bearing, long-lasting antibiotic therapy, improving circulation and topical treatment-debridement.
BACKGROUND: Ulceration of the feet, which can result in loss of limbs and even death, is one of the major health problems for people with diabetes mellitus. OBJECTIVES: To assess the effectiveness of patient education on the prevention of foot ulcers in patients with diabetes mellitus. SEARCH STRATEGY: Eligible studies were identified by searching the Wounds Group Specialised Trials Register, which is compiled from regular searches of the major health care databases including MEDLINE, Cinahl and EMBASE, hand searching of wound care journals and relevant conference proceedings. For this review the Register was searched up to March 2001. SELECTION CRITERIA: Prospective randomised controlled trials (RCTs) which evaluated educational programmes for the prevention of foot ulcers in people with diabetes mellitus. There was no restriction on language of the publications. DATA COLLECTION AND ANALYSIS: Data extraction and assessment of study quality were undertaken by two reviewers independently. MAIN RESULTS: The methodological quality of the 8 included RCTs was poor. The internal validity score (range 0 - 10) of individual RCTs ranged from 2 to 4. Four trials compared the effect of intensive with brief educational interventions; 2 of these reported clinical endpoints. One study involving high-risk patients reported a reduction in ulcer incidence (Peto OR: 0.28 (95% CI 0.13,0.59)) and amputation rate (Peto OR: 0.32 (0.14,0.71)) after 1 year. The other RCT did not find an effect at seven years follow-up. Participants' foot care knowledge significantly improved with education in 2 trials. In one trial, foot care knowledge was significantly worse at 6 months, although foot care behaviour improved significantly. Non-calcaneal callus was significantly reduced by education in one trial. One RCT did not find that patient foot care education, as part of a general diabetes education program reduced foot ulceration compared with usual care. Patient education as part of a complex intervention targeted at both people with diabetes and doctors reduced the number of serious foot lesions at one year, in one RCT (OR: 0.41(0.16-1.00)) and improved foot care behaviour. Evidence from 2 RCTs comparing the effect of patient-tailored education in addition to usual care was conflicting. REVIEWER'S CONCLUSIONS: RCTs evaluating education for people with diabetes, aimed at preventing diabetic foot ulceration, are mostly of poor methodological quality. Existing data suggests that patient education may reduce foot ulceration and amputations, especially in high-risk patients. Foot care knowledge and behaviour of patients seem positively influenced by patient education in the short term. Because of conflicting results and the methodological shortcomings more RCTs are needed.
Foot ulceration in diabetic patients is a resource-consuming, disabling morbidity that often is the first step in the downward spiral to lower extremity amputation. The best treatment is prevention. Prevention of foot ulcers requires a coordinated program of foot-specific patient education, prophylactic skin and nail care, and protective footwear. The goal of prescription footwear is to keep individuals ambulatory, while protecting them from ulcer formation. The complexity of pedorthic prescription increases with decreasing protective sensation and increasing structural deformity of the foot and ankle. Prescription footwear accommodates deformity, while decreasing pressure and shear forces applied to skin overlying bone prominences.