Management of the Diabetic Foot: Preventing Amputation

Marvin E. Levin, MD

Disclosures

South Med J. 2002;95(1) 

In This Article

Patient Education

Patient education in foot care and foot inspection is the most important factor in preventing amputation. Patients should be taught to inspect their feet on a daily basis, and shoes and socks must be removed for foot inspection during every office visit. The nurse and/or physician should inspect the patient's feet and review the "dos and don'ts" of foot care ( Table 7 ). A successful foot-care education program cannot be accomplished by simply handing the patient a list of instructions. Instead, the list of instructions should be reviewed with and explained to the patient and questions should be encouraged. Foot-care instructions should be reviewed with the patient at least once a year and preferably more often. The effectiveness of educational programs in reducing amputation has been well documented.[64,65]

One of the most important factors in saving the foot of the diabetic patient is inspection of the foot at each office visit, including checking between the toes; unfortunately, this simple examination is frequently omitted. In one series, only 61% of the patients had their feet inspected at least once.[66] In one managed care program, examination of the feet was not noted in 94% of the patients' records.[67] A percentage of these patients may have had their feet examined but not documented; however an often-quoted caveat is that if it was not recorded, it was not done.

Diabetic patients with loss of sensation in their feet and previous ulcers and foot deformities should not do weight-bearing exercises such as jogging, walking on a treadmill, prolonged walking, or step exercises. Exercises that are acceptable for the diabetic patient with loss of sensation include swimming, bicycling, rowing, chair exercises, and arm exercises.[68]

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