Diabetic Foot Education and Self Care

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Patient education

Several surveys have identified deficits in the skills and knowledge in the abilities of self care in those with foot ulcers and/or amputation ; Masson et al, 1992).

Foot self-management occurs in several different contexts, depending on the natural history of the diabetes:
1) As part of the initial education program at the time of diagnosis
2) As part of the annual review when risk factors for all diabetes complications should be discussed
3) When the foot is at high risk of tissue damage or a lesion has developed

APodC Guidelines:
The Podiatrist should, on initial assessment and at all subsequent
visits,
assess EITHER the person's ability to perform safe and adequate
self-care
OR the adequacy of assisted care.

If the person is unable or unwilling to maintain an adequate level of
self-care, they may place their foot health at risk.

Within any consultation, the treating Podiatrist should be aware of the
need to identify and monitor the following:

q Vision - can the person see their feet?
q Foot hygiene - can they physically reach their feet to perform
tasks?
q Foot care knowledge - do they appreciate and understand the
reasons
for taking extra care of their feet?
- do they understand their particular risk factor relevance?
q Assistance - does the person have someone else who they may
ably
assist them if they are unable to perform self care.

EDUCATION GUIDELINES

The following six standards/guidelines which cover the basic issues of
foot
care should be communicated to the person by Podiatrists.

The Podiatrist should ensure during the assessment and education
process
that these are addressed in the most appropriate manner for each
person.

Guideline 1
The person with diabetes should have an understanding of the effects of
diabetes on foot health.

This is met when the person can:

1.1 Identify the reasons why the feet and legs are at risk due to
their
diabetes.

1.2 Show understanding of the risks inherent with diabetes by
implementing recommended changes to footwear, footcare, activity
patterns
and lifestyle behaviours.

1.3 Take responsibility for the management and monitoring of daily
foot
health care, in association with the Podiatrist and other health care
workers (where applicable)

Guideline 2
The person with diabetes should have an understanding of proper
footwear
choice and its purpose.

This is met when the person can recognise:

2.1 That shoes offer protection from injury

2.2 That shoes must fit correctly to protect (and not injure) the
feet

2.3 That footwear should be suitable for the occasion

Guideline 3
The person with diabetes should be able to identify and effectively
manage
risk factors which may result in foot problems.

This is met when the person can:

3.1 State the complications of diabetes which result in the foot
being
put at risk

3.2 Describe how to help prevent the onset or results of these
complications

3.3 Carry out preventative treatment strategies when there are
complications affecting the lower limb or foot

Guideline 4
The individual should understand the importance of monitoring blood
glucose
and lipid levels and the potential effect of continued hyperglycaemia
and
hyperlipidaemia on foot health.

This is met when the person can:

4.1 Identify what constitutes a high blood glucose level

4.2 Identify the relationship between high blood glucose levels and
infections and the importance of seeking medical assistance

4.3 Identify what constitutes a high blood lipid level

4.4 Understand the long-term relationship between hyperglycaemia,
hyperlipidaemia and the development of complications which may affect
foot
health

Guideline 5
The person with diabetes will be able to identify the services
available
for assistance, their role and appropriate use.

This is met when the person can:

5.1 Describe the role of the

a) Podiatrist
b) General Practitioner
c) Specialist
d) Diabetes educator
e) Dietitian

5.2 Identify the services they would access when an acute foot
problem
arises.

5.2.1 State how they would contact them

5.3 State appropriate additional resources which may be useful in
their
care (viz. Diabetes Australia)

Guideline 6
The person with diabetes should be involved in self-care to maintain
optimal foot health

This is met when:

6.1 The person who has diabetes is able to:

6.1.1 Identify and effectively manage risk factors which may result
in
foot problems.

6.1.2 Act on early warning signs of development of foot or lower limb
problems

6.1.3 Seek help appropriately

6.2 The person with diabetes is able to discuss and demonstrate
skills
in foot care that ensure that they are capable of independent self care

Delivery of education:

No differences demonstrated between group and individual education .

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