Feet Can Last a Lifetime: A Health Care Provider’s Guide to Preventing Diabetes Foot Problems

National Hospital Discharge Survey Data indicate that 86,000 people with diabetes in the United States underwent one or more lower-extremity amputations in 1996. Diabetes is the leading cause of amputation of the lower limbs. Yet it is clear that as many as half of these amputations might be prevented through simple but effective foot care practices. The 1993 landmark study, the Diabetes Control and Complications Trial funded by the National Institute of Diabetes and Digestive and Kidney Diseases, conclusively showed that keeping blood glucose, as measured by hemoglobin A1c, as close to normal as possible significantly slows the onset and progression of diabetic nerve and vascular complications, which can lead to lower extremity amputations. People who have diabetes are vulnerable to nerve and vascular damage that can result in loss of protective sensation in the feet, poor circulation, and poor healing of foot ulcers. All of these conditions contribute to the high amputation rate in people with diabetes. The absence of nerve and vascular symptoms, however, does not mean that a patient’s feet are not at risk. Risk of ulceration cannot be assessed without careful examination of the patient’s bare feet. Early identification of foot problems and early intervention to prevent problems from worsening can avert many amputations. Good foot care, therefore, is an essential part of diabetes management – for patients as well as for health care providers. This kit is designed for primary care and other health care providers who counsel people with diabetes about preventive health care practices, particularly foot care. “Feet Can Last a Lifetime” is designed to help you implement four basic steps for preventive foot care in your practice: Early identification of the high risk diabetic foot, Early diagnosis of foot problems, Early intervention to prevent further deterioration that may lead to amputation, and Patient education for proper care of the feet and footwear.