This paper aimed to discuss the importance of prevention and the authors’ protocol for prevention – in the form of education and foot screening – and to review the existing evidence in the literature regarding the effectiveness of the preventive approach.
Both professional and patient education, and foot screening are required to prevent diabetic foot problems, with the help of government intervention to run knowledge-based, screening programmes on a national scale.
The key to prevention of diabetic foot problems is information. While this should be mainly given to patients and caregivers, professionals should first understand the nature of patient education.
Once trained and better informed, they can then effectively pass on this knowledge to patients and caregivers.
The International Working Group on the Diabetic Foot strongly recommended increasing knowledge on footwear and encouraged education for foot care.
Professionals who require this type of knowledge include general practitioners, doctors, nurses and allied health professionals in hospitals and primary healthcare centres.
Materials that should be made available include books and online materials. Other materials can include pamphlets given by institutions.
The purpose of foot screening is to detect signs of the ‘foot at risk’. This refers to a foot with the potential to ulcerate.
The four key signs of the foot at risk are loss of protective sensation (peripheral neuropathy), one or both distal pulses not being palpable (peripheral arterial disease), presence of foot deformity or callosity, and inability to reach the foot or visual impairment.
The risk stratification tool by Leese et al can be used to predict the risk of foot ulceration. The tool classifies the foot into one of three categories: low, moderate or high risk.
This stratification is based on four clinical criteria: patient history, foot pulses, monofilament testing and foot deformity.
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