Prevention of Diabetic Foot Ulcers at Primary Care Level

Abstract

Diabetic foot ulcer (DFT) prevention is best achieved at primary care level and should begin with education, appropriate protective
footwear, glycaemic control and regular screening for loss of protective sensation. In the west, specialized diabetic or
podiatry clinics may assess and quantify neuropathy with many tools including monofilaments, biothesiometry, corneal confocal
microscopy and nerve conduction studies. Vascular assessment can be done via measuring ankle-brachial index, duplex ultrasound
studies and toe pressure. Other foot assessment may include measuring plantar foot pressure using computerized dynamic foot
studies (computerized insole sensor system). The ability to stratify patients based on risks is carried out on the basis of a thorough
medical and surgical history in conjunction with these measurements thereby allowing clinicians to determine the type of intervention.
Effective strategies for foot ulceration prevention include educating patients, their families, and healthcare workers about
adequate foot care and regular foot examinations along with optimal glycaemic control and smoking cessation. Other effective
clinical interventions may include, foot hygiene, debridement of calluses, management of foot deformities which may at times
require prophylactic foot surgery. Counseling patients regarding daily proper footwear and hygiene should be stressed during each
clinic visit. Educating, screening and managing patients with diabetic foot ulceration and or complications is an essential primary
healthcare strategy to prevent unnecessary morbidity and mortality related to diabetic foot. An integrated (interdisciplinary) approach
including, family physicians with special interest in the diabetic foot, diabetic educators, nurses and family members is a
vital component in this regard.