The influence of beliefs about health and illness on foot care in diabetic subjects with severe foot lesions: a comparison of foreign- and Swedish-born individuals

Objective: To explore beliefs about health and illness among foreign-born and Swedish diabetic men with severe diabetic foot lesions that might affect self-care and care-seeking behaviour.Design: Explorative study with consecutive sampling. Focus group interviews with 11 Swedish-born men and individual interviews with 15 foreign-born men, aged 38–74 years (mainly Europeans) with present or previous diabetic foot lesions.Results: Foreign-born men often attributed the ulcer to work-related accidents outside their control, perceived the occurrence of an ulcer as a trifle, stated lack of information about foot care and management of diabetes, showed passive self-care behaviour and visited health professionals when they had new foot problems. Swedes discussed more foot problems, expressed great fears and anxiety when having an ulcer, had a higher degree of knowledge about foot care, showed active self-care behaviour and tried to prevent foot ulcers. In both groups foot lesions caused deterioration of perceived health and quality of life due to decreased level and ability to be active.Conclusion: Beliefs about health and illness differed between foreign- and Swedish-born men and affected self-care and care-seeking behaviour. Their beliefs need to be considered in prevention and management of the diabetic foot. Many patients, especially foreign-born, have an underutilised potential for self-care measures.     

Promoting foot self-care in type 2 diabetes mellitus patients receiving hemodialysis based on the information-motivation-behavioral skills model

This study develops and verifies the use of the foot self-care behavioral model in patients with type 2 diabetes mellitus (T2DM) receiving hemodialysis (HD) based on the information-motivation-behavioral skills model. Data were collected between June and August 2021 from 156 outpatients with type 2 diabetes who were receiving regular HD. A structured questionnaire and electronic medical records were used to collect demographic and disease-related data along with Foot Care Knowledge Questionnaires, third version of Diabetes Attitude Scale, Multidimensional Scale of Perceived Social Support, Foot Care Confidence Scale, and Foot Self-care Behavior Scale. Age, diabetic foot care knowledge, social support, and foot care self-efficacy had a direct effect on foot self-care behavior. Foot care self-efficacy had a mediating effect on foot care knowledge, diabetes-related attitudes, social support, and foot self-care behavior. The information-motivation-behavioral skills model was suitable as a foot self-care behavioral model for patients with T2DM receiving HD. Additionally, these findings suggest that it is crucial to improve foot self-care behavior through increased foot care knowledge, diabetes-related attitudes, and social support, which could contribute to enhancing foot care self-efficacy.     

Gender influences beliefs about health and illness in diabetic subjects with severe foot lesions

BACKGROUND: No studies have been found regarding beliefs about health and illness in patients with diabetic foot ulcers investigated from a patient perspective. Beliefs might affect self-care and health. AIM: To explore beliefs about health and illness among patients with severe diabetic foot lesions that might affect self-care practice and care-seeking behaviour. METHOD: The study design was explorative. A purposive sampling procedure was used. Focus group interviews were held, with 10 women and 11 men under 65 years (working age) and six women and 12 men over 65 years (range 23-83 years) with present or previous diabetic foot lesions managed at a specialized multidisciplinary diabetic foot clinic. FINDINGS: Foot problems were perceived by participants as caused by both external and internal factors related to the individual. Self-care was practised to restore health when ill and in daily foot care. When help was needed it was sought in the professional sector. Women were active in self-care and preventive care, searched for information and tried to adapt to the situation. Men more often sought help for acute problems, discussed more foot-related problems, had a pessimistic view of the future, showed a passive attitude, accepted information given and used more complementary care from the lay sector (wife) and/or the professional sector (district nurse, home care staff, podiatrist). Foot lesions caused deterioration of perceived health and quality of life due to decreased ability to be active. CONCLUSION: The present study emphasizes the need to take into account the existence of different beliefs about health and illness, especially regarding gender, in the prevention and management of the diabetic foot.     

Benefits of a multidisciplinary approach in the management of recurrent diabetic foot ulceration in Lithuania: a prospective study.

OBJECTIVE: To assess the ability of a multidisciplinary approach to diabetic foot care to reduce the incidence of recurrent ulceration and amputations compared with standard care in a 2-year prospective study. RESEARCH DESIGN AND METHODS: A total of 145 patients with a past history of neuropathic foot ulcers but no evidence of peripheral vascular disease entered the study. Subjects were screened for their neuropathic and vascular status at baseline, and all received identical foot care education. The intervention group (n = 56) was followed by the multidisciplinary team of physicians, nurses, and podiatrists with regular podiatry and reeducation every 3 months and the provision of specialty footwear as required. The standard treatment group was followed in local clinics on a trimonthly basis and received identical screening and education at baseline. RESULTS: There were no significant differences at baseline in age (intervention 59.2+/-13.4, standard treatment 58.5+/-11.5 years), duration of diabetes (14.0+/-7.1 vs. 15.6+/-7.8 years), or neuropathic status (vibration perception threshold [VPT]: 31.1+/-12.1 vs. 33.9+/-11.3 V, neuropathy disability score [NDS]: 8.1+/-1.4 vs. 7.9+/-1.7). All patients had an ankle brachial pressure index (ABPI) of >0.9 and at least one palpable foot pulse. Significantly fewer recurrent ulcers were seen in the intervention group than in the standard treatment group during the 2-year period (30.4 vs. 58.4%, P < 0.001). CONCLUSIONS: This prospective study has demonstrated the effectiveness of a multidisciplinary approach to diabetic foot care together with the provision of specialty footwear in the long-term management of high-risk patients with a history of neuropathic foot ulcers.     

Clinical and functional correlates of foot pain in diabetic patients

Purpose: Patients with diabetes mellitus frequently suffer from foot pain. This pain seems to be a neglected area in studies on the diabetic foot. The purpose of this study was to identify clinical variables associated with foot pain in diabetic patients. In addition, the relationships between foot pain and several functional impairments and disabilities were explored.

Method: The research group consisted of 29 diabetic patients with any symptoms possibly associated with a diabetic foot, who were referred to podiatry. The relationships between several clinical measures and foot pain were analysed by means of Mann-Whitney U-tests. In addition, Spearman rank correlations coefficients were computed to assess the relationships between foot pain and measures of functional health.

Results: Diabetic patients suffering from sensory neuropathy experience more severe foot pain. Furthermore, patients with more severe foot pain experience more fatigue, more disabilities in walking and a lower level of affective well-being.

Conclusion: Based on these findings this paper concludes that foot pain in diabetic patients is an important impairment, which deserves further scientific attention.     

糖尿病足简式联合评估与超前护理应用效果观察

目的观察糖尿病足简式联合评估与超前护理的应用效果。方法将糖尿病足简式联合评估与超前护理实施前(2017年1月~11月)和实施后(2017年12月~2018年10月)收治于我院的各150例糖尿病患者作为观察对象,实施前后分别设为对照组和试验组。对照组接受糖尿病常规护理。试验组在对照组的基础上加用糖尿病足简式联合评估与超前护理干预。并对两组干预后的各观察指标进行比较。结果试验组糖尿病足风险主动评估率、足部护理知识及足部自护行为评分显著高于对照组,一年内糖尿病足发生率显著低于对照组(P<0.05)。结论采用糖尿病足简式联合评估与超前护理进行糖尿病足预防护理,可显著提升护理人员糖尿病足风险主动评估率,促进糖尿病患者足部自护知识及自护行为水平的提高,降低糖尿病足发生风险。     

利用足部护理箱开展老年糖尿病患者糖尿病足的健康教育

目的：提高老年糖尿病患者足部护理能力。方法对80例住院老年糖尿病患者,应用足部护理箱,开展有关糖尿病足相关知识的健康教育。内容包括对糖尿病足的早期筛查,糖尿病足日常护理,足部的检查,选择合适的鞋袜,促进肢体血液循环的锻炼和糖尿病足部常见问题等。结果干预2周采用自制“糖尿病足部自护能力评估表”评价80例患者的足部自护能力。结果显示：教育后,患者对足部糖尿病各项相关知识知晓率达到91%～96%,患者都建立了自己的足部护理箱。结论采用图、文及教育工具相结合的教育方式,符合老年人的特点,能激发患者学习兴趣,有效提高健康教育效果和患者的足部护理能力。     

糖尿病足患者足部自护能力及健康需求的调查

目的探讨糖尿病足患者足部自护能力及健康需求情况。方法采用自行设计的问卷调查表,对80例糖尿病足患者进行足部自护能力及健康需求调查。结果患者对糖尿病基本知识、对糖尿病足的认识、足部保健知识、正确的穿鞋袜知识、正确的修剪指甲知识等了解甚少,93.8%的患者希望接受糖尿病足知识教育。结论医护人员应加强对糖尿病患者糖尿病足知识的健康教育,提高患者的自护能力。     

The current status of foot self-care knowledge,behaviours, and analysis of influencing factors in patients with type 2 diabetes mellitus in China

PurposeTo investigate the knowledge and behaviours on foot self-care in patients with type 2 diabetes mellitus; analyse the influential factors, and provide information for the intervention study.MethodsA total of 5961 patients with type 2 diabetes mellitus from 144 hospitals in China were included in the study. The investigation content included patients' demographic data, foot self-care knowledge and behaviours. The investigation tools were the questionnaires on the general diabetes information, on the foot self-care knowledge, and on the foot self-care behaviours.ResultsThe foot self-care knowledge was medium and the foot self-care behaviour was poor. The status of knowledge and behaviours were influenced by education, duration of diabetes mellitus, periodic inspection, and education about diabetic complications. Pearson analysis demonstrated that there was positive correlation between knowledge score and behaviour score (r = 0.27, p < 0.001).ConclusionsThe status of foot self-care knowledge and behaviours are not optimistic. According to the patients' own characteristics, the theory of knowledge, attitude and practice applies to encouraging patients to go for periodic inspection and education about diabetic complications so as to enhance the knowledge and promote the self-care behaviours.     

Efficacy of injected liquid silicone in the diabetic foot to reduce risk factors for ulceration: a randomized double-blind placebo-controlled trial

OBJECTIVE: To investigate the effectiveness of injecting liquid silicone in the diabetic foot to reduce risk factors for ulceration in a randomized double-blind placebo-controlled trial. RESEARCH DESIGN AND METHODS: A total of 28 diabetic neuropathic patients without peripheral vascular disease were randomized to active treatment with 6 injections of 0.2 ml liquid silicone in the plantar surface of the foot or to treatment with an equal volume of saline (placebo). No significant differences were evident regarding age or neuropathy status between the 2 groups. All injections were under the metatarsal heads at sites of calluses or high pressures. Barefoot plantar pressures (pedobarography) and plantar tissue thickness under the metatarsal heads (Planscan ultrasound device) were measured at baseline and at 3, 6, and 12 months after the first injection. Injection sites were photographed at all stages, and callus formation was scored as a change from baseline. Throughout the study, patients were treated by the same podiatrist for all podiatry treatment. RESULTS: Patients who received silicone treatment had significantly increased plantar tissue thickness at injection sites compared with the placebo group (1.8 vs. 0.1 mm) (P < 0.0001) and correspondingly significantly decreased plantar pressures (-232 vs. -25 kPa) (P < 0.05) at 3 months, with similar results at 6 and 12 months. A trend was noted toward a reduction of callus formation in the silicone-treated group compared with no change in the placebo group. CONCLUSIONS: The results confirm the efficacy of plantar silicone injections in reducing recognized risk factors associated with diabetic foot ulceration.     

Diagnosis and Management of Plantar Fasciitis in Primary Care

Patients with foot pain present to their primary care providers for treatment. Plantar fasciitis is easily diagnosed based on history and exam with little to no need for diagnostic testing. Initial treatment is conservative and is easily initiated in the primary care office, with the focus on alleviation and resolution of the foot pain. Initial treatment modalities include taping, icing, proper footwear, stretching, and rest. When pain persists, other modalities include night splints or referrals to physical therapy and podiatry or orthopedic or sports medicine for a corticosteroid injection.     

Observation of the effect of one-to-one education on high-risk cases of diabetic foot

BACKGROUNDDiabetes is a common chronic disease, and its global incidence is on the rise. The disease is directly attributed to insufficient insulin efficacy/secretion, and patients are often accompanied by multiple complications. Diabetic foot is one of the most common complications of diabetes. Diabetic feet have ulcers and infections, which can eventually lead to amputation. Basic nursing care, such as lowering blood pressure and preventing foot skin infections in clinical nursing work, has positive significance for the prevention and control of diabetic feet.AIMTo explore the positive significance of one-to-one education in high-risk cases of diabetic foot.METHODSThis observation included 98 high-risk cases of diabetic foot in our hospital during the period from August 2017 to October 2019, and these patients were randomly divided into the basic nursing group and the one-to-one education group with 49 patients per group. The basic nursing group only received routine basic nursing, while the one-to-one education group gave patients one-to-one education on the basis of basic nursing. After nursing, the self-care ability and compliance behavior of the two groups were evaluated and compared between these two groups. The knowledge mastery of the patient and the satisfaction of nursing were accounted.RESULTSThe assessment results of patients (self-care responsibility, self-care skills, self-concept and self-care knowledge) were significantly higher in the one-to-one education group than in the basic nursing group. The scores of compliance behaviors (foot bathing, shoes and socks selection, sports health care) in the one-to-one education group were significantly higher than those in the basic nursing group. Patients in the one-to-one education group had a significantly higher level of knowledge mastery and satisfaction of nursing than the basic nursing group.CONCLUSIONOne-to-one education for high-risk cases of diabetic foot is helpful to improve the cognition and self-care ability of patients with diabetic foot, to ensure that patients follow the doctor’s advice of self-care and to improve their nursing satisfaction.     

A foot care program for diabetic unilateral lower-limb amputees

OBJECTIVE: To assess the efficacy of a specialist foot care program designed to prevent a second amputation and to assess peripheral vascular disease (PVD) and peripheral neuropathy in diabetic unilateral lower-limb amputees. RESEARCH DESIGN AND METHODS: Investigations were carried out in 143 diabetic lower-limb unilateral amputees referred to a subregional rehabilitation center for prosthetic care from a catchment area of approximately 3 million people. Peripheral vascular and nerve assessment, education, and podiatry were provided for each patient. RESULTS: For the patients referred to the foot care program, there were no baseline differences between the patients who proceeded to a bilateral amputation (n = 22) and those who remained as unilateral amputees (n = 121) in their level of foot care knowledge and mean neuropathy scores. Mean ankle-brachial pressure index was significantly lower for the bilateral amputees (0.75 +/- 0.04) compared with the unilateral amputees (0.90 +/- 0.03, mean +/- SEM, P < 0.05), but there was no difference in the level of oxygen in the skin. However, the level of carbon dioxide was significantly lower in patients with bilateral amputation (24.21 +/- 2.16 vs. 31.20 +/- 0.85 mmHg, P < 0.03). Overall, the establishment of a specialist foot care program made no impact on contralateral limb amputation (22 of 143, 15.4%) compared with matched patients without the program (21 of 148, 14%) over a 2-year outcome period for each patient. CONCLUSIONS: PVD is more closely associated with diabetic bilateral amputation than neuropathy or level of foot care knowledge. Preventative foot care programs for diabetic unilateral amputees should therefore place greater emphasis on peripheral vascular assessment to identify patients at risk and on the development of timely intervention strategies.     

患者积极度在糖尿病足患者家庭功能与健康促进自我护理间的中介作用

目的：探讨患者积极度在糖尿病足患者家庭功能与健康促进自我护理间的中介作用。方法：采用自行设计一般资料调查表、糖尿病患者健康促进自我护理量表、患者积极度量表、家庭功能量表对223例糖尿病足患者进行调查。结果：糖尿病足患者健康促进自我护理总分为（90.72±15.51）分,处于中等水平,其中锻炼得分最低,遵医嘱治疗得分最高;糖尿病足患者积极度总分为(56.37±13.83)分,处于第三水平;糖尿病足患者家庭功能条目均分为（2.24±0.37）分,处于中等水平。糖尿病足患者家庭功能与健康促进自我护理、患者积极度呈负相关（P＜0.001）、患者积极度与健康促进自我护理呈正相关（P＜0.001）。患者积极度在家庭功能、健康促进自我护理间发挥中介作用,中介效应占总效应比为32.47%。结论：临床护理人员需重视患者本身在治疗过程中的主动性和投入程度,提升家庭成员的行动支持和情感包容,尤其通过强化家庭的治疗主动性带动患者积极治疗的态度、提高自我护理能力。     

Effectiveness of a Collaborative Nursing Care Model for the Treatment of Patients with Diabetic Foot Disease by Transverse Tibial Bone Transport Technique: A Pilot Study

PurposeMedical staff shortages remain a serious challenge, particularly to medical administrators. We aimed to analyze the effectiveness of a collaborative nursing care model in treatment of diabetic foot.DesignA quasi-experimental pilot study.MethodsTwenty-eight patients with diabetic foot treated by transverse tibial bone transport between January 2017 and March 2018 were randomized. The observational group received collaborative nursing care, while the control group received usual nursing care. Postoperative dorsal foot skin temperature, visual analog scale, self-rating anxiety scale (SAS) score, and other endpoints were assessed.FindingsPostoperative dorsal foot skin temperature was significantly higher in the observation group than in the control group. Visual analog scale and SAS scores were significantly lower in the observational group than in the control group.ConclusionsThe collaborative nursing care model enhanced collaboration between patient and health care providers, shortened hospital stay, and relieved postoperative pain and anxiety.     

Self-care behaviors for muscle pain

This investigation examined self-care behaviors for muscle pain because of the prevalence of musculoskeletal pain and the substitution of self-care for formal medical care. In Study 1, university students (N = 187) completed a retrospective questionnaire about self-care for muscle pain. In Study 2, muscle pain was experimentally induced in university students (N = 79) with subsequent measurement of self-care. In both studies, stretching and massaging were the most frequently performed behaviors, and consuming medication was the least frequently performed. In Study 1, the perceived effectiveness of behaviors and level of pain required to perform self-care accounted for 12% to 32% of the variance in behavior frequency. In Study 2, pain ratings and pain during activities were higher among those who performed self-care (ds = .59 to 1.00). These studies indicated that self-care behaviors are performed for both naturally occurring and experimentally induced muscle pain. However, both studies determined that the performance of self-care behaviors did not always correspond with current evidence of treatment effectiveness for muscle injuries. Unique opportunities for future investigations of self-care behavior models and interventions are permitted by muscle pain induction. PERSPECTIVE: Self-care for pain reduction is an understudied behavior. This report describes 2 studies of self-care behaviors for naturally occurring and experimentally induced muscle pain. The most frequent types of self-care behaviors are similar for the types of pain, and the perceived effectiveness of behaviors and pain level influence performance of the behaviors.     

并发症体验对2型糖尿病患者自我管理能力的影响2011—12一12

目的探讨并发症体验对2型糖尿病患者自我管理能力的影响。方法将116例2型糖尿病患者分为试验组和对照组。试验组采用并发症体验干预方式,对照组采用常规干预方法。比较出院后第1、3个月两组患者自我管理能力。结果不同干预方式患者血糖监测行为、足部护理行为及自我管理能力总体得分差异有统计学意义（P〈0.05）,但饮食行为、运动行为得分差异无统计学意义（P〉0.05）。结论并发症体验可以提高2型糖尿病患者的自我管理能力,对血糖监测、足部护理行为的改善效果较好,可以尝试在临床中推广。     

Personal and treatment factors associated with foot self-care among veterans with diabetes

We developed and validated a survey of foot self-care education and behaviors in 772 diabetic patients with high-risk feet at eight Department of Veterans Affairs medical centers. Principal components analysis identified six subscales with satisfactory internal consistency: basic foot-care education, extended foot-care education, basic professional foot care, extended professional foot care, basic foot self-care, and extended foot self-care (alpha = 0.77-0.91). Despite high illness burden, adherence to foot self-care recommendations was less than optimal; only 32.2% of participants reported looking at the bottom of their feet daily. Independent predictors of greater adherence to basic foot self-care practices included African-American or Hispanic background, perceived neuropathy, foot ulcers in the last year, prior amputation (beta = 0.08- 0.12, p < 0.04-0.001), and provision of greater basic and extended education (beta = 0.16, p < 0.004, and beta = 0.15, p < 0.007). The survey subscales can now be used for evaluating foot care and education needs for persons with high-risk feet.     

Amputation prevention by vascular surgery and podiatry collaboration in high-risk diabetic and nondiabetic patients. The Operation Desert Foot experience.

OBJECTIVE: To describe a unique multidisciplinary outpatient intervention for patients at high risk for lower-extremity amputation. RESEARCH DESIGN AND METHODS: Patients with foot ulcers and considered to be high risk for lower-extremity amputation were referred to the High Risk Foot Clinic of Operation Desert Foot at the Carl T. Hayden Veterans Affairs' Medical Center in Phoenix, Arizona, where patients received simultaneous vascular surgery and podiatric triage and treatment. Some 124 patients, consisting of 90 diabetic patients and 34 nondiabetic patients, were initially seen between 1 October 1991 and 30 September 1992 and followed for subsequent rate of lower-extremity amputation. RESULTS: In a mean follow-up period of 55 months (range 3-77), only 18 of 124 patients (15%) required amputation at the level of the thigh or leg. Of the 18 amputees, 17 (94%) had type 2 diabetes. The rate of avoiding limb loss was 86.5% after 3 years and 83% after 5 years or more. Furthermore, of the 15 amputees surviving longer than 2 months, only one (7%) had to undergo amputation of the contralateral limb over the following 12-65 months (mean 35 months). Compared with nondiabetic patients, patients with diabetes had a 7.68 odds ratio for amputation (95% CI 5.63-9.74) (P < 0.01). CONCLUSIONS: A specialized clinic for prevention of lower-extremity amputation is described. Initial and contralateral amputation rates appear to be far lower in this population than in previously published reports for similar populations. Relative to patients without diabetes, patients with diabetes were more than seven times as likely to have a lower-extremity amputation. These data suggest that aggressive collaboration of vascular surgery and podiatry can be effective in preventing lower-extremity amputation in the high-risk population.