Αccepted Article

Journal of Research and Practice

on the Musculoskeletal System
JOURNAL OF RESEARCH AND PRACTICE
ON THE MUSCULOSKELETAL SYSTEM

Mini Review

Nurses as educators of diabetic foot patients

Antonia Tassiou
Vascular Surgery clinic, General Hospital of Attika “KAT”, Athens, Greece

Abstract
The present article is a mini review on the multi-faceted role of the nurse in relation to the education of the patient
with diabetic foot disease, a severe medical condition with worldwide prevalence and immense financial and clinical
implications. We present a mini review based on scientific articles written in English concerning the role of the
nurse in the areas of prevention, care and rehabilitation focusing on their contribution in educating the diabetic foot
patients and their relatives to recognize the symptoms of diabetic foot, helping them follow simple and basic rules
that will prevent the onset or further development of the disease, informing them as to the available treatment
options during care and eventually supporting them in the road to lead a fulfilling life.

Keywords: Nurse, Diabetic foot education, Prevention, Care, Rehabilitation

Introduction team approach7. The specialists in these teams usually

are general practitioners, nurses, orthotic consultants,
Diabetes mellitus (DM) is a disease that affects podiatrists, vascular surgeons, infection disease specialists,
millions of people worldwide acquiring the form of a endocrinologists, dermatologists, dieticians, psychologists/
universal epidemic disorder. According to the World psychotherapists and orthopedic specialists8,9. Even though
Health Organization, the number of diabetic patients has every team member has a very important functional role, the
risen from 108 million in 1980 to 422 million in 20141, role of the nurse in the team is exceptional9 because they are
with “moderate” projections of diabetic foot patients involved not only in the fields of care and rehabilitation after the
reaching 366 million by 20302. It is evident that this onset of the disease, but also in the field of prevention. Given
rapidly evolving problem requires the close collaboration the fact that diabetic foot ulcerations are preventable10,11
of health care providers with patients and families in order if the patient and/or his family receive proper education
to achieve the implementation of effective strategies that as to the symptoms and management of the disease, one
will alleviate the dire complications of the disease. can understand the different and important roles the nurse
DM has several severe complications and the diabetic can assume as an educator, consultant, care provider and
foot disease is considered among the most common as connector, researcher and supporter of the patient’s rights12.
well as one of the most devastating. Diabetic foot disease
is defined as a foot affected by ulceration that is the result Methods
of neuropathy or peripheral arterial disease of the lower
For the purposes of this review searches were conducted
limb in a patient suffering from diabetes3. Whereas diabetic
in various online databases (Cochrane Library, Medline/
foot ulceration in diabetic patients ranges between 4-10%,
studies show that about 5% of all patients with diabetes
will develop some form of foot ulceration4, while the risk of
developing foot ulceration among diabetic patients during The author has no conflict of interest.
their lifetime reaches 15%4. Moreover, 15-20% of all Corresponding author: Antonia Tassiou, 148 Pefkon Str,
patients with foot ulcers will eventually need lower limb 141-22 Neo Heraklion, Athens, Greece
amputation5. If the patient with diabetic foot ulceration does E-mail: adatassiou@yahoo.com
not receive the necessary care, the infected ulcers can lead Edited by: Konstantinos Stathopoulos
to severe infections, gangrene and even death6. Accepted 28 August 2019
Among the best preventive strategies in the battle
against diabetes and its complications is the multidisciplinary

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 A. Tassiou

PubMed, Google Scholar) and search was also conducted is very important since the nervous system that controls
via other search engines. From the 93 articles, studies, sweating is impaired and the cream keeps the feet moist.
and reviews collected which were published internationally Care should be taken not to apply cream between the toes
between January 1995 and October 2018 in the English as this could lead to infections. The toenails should also be
language, with the use of keywords: nurse, diabetic foot carefully trimmed after washing the feet in lukewarm water
education, prevention, care and rehabilitation, 19 were when they are softer and in a straight line to prevent cuts
selected, on the basis of relevance to the subject. Exclusion in the skin of the toes, and the patient should be advised to
criteria were articles focusing on specific types of diabetes always wear clean and dry socks.
and specific types of diabetic patient groups. From the
selected articles’ bibliography, 7 articles were also included Appropriate footwear
in the review. The choice of correct footwear is key for the low risk
diabetic patient. The risk of permanent foot damage due
Results to the wrong size or style, e.g. pointy shoes, is very high
The nurse as educator in the prevention, care and and can lead to feet deformity, calluses and eventually
rehabilitation of the diabetic foot patient ulcer formation due to the fact that the diabetic patient
suffers from sensory loss and may not feel the injury until
Prevention
it is too late15. More than 55% of foot ulcers are caused
The education of the patient and his/her environment by pressure caused by poor footwear16. The high risk
plays an instrumental role in the prevention of the diabetic diabetic patient should opt for orthopedic footwear with
foot syndrome. Many diabetic patients may not know or may sufficient toe space to accommodate minor deformities,
not be in a position to understand the importance of proper broad base for better support and traction as well as foam
care of their feet. The first step for the nurse is therefore padding for cushioning17.
to assess the patient’s self-care capacity and establish
communication that will help with the next steps. This can Lifestyle changes
be achieved either with the patient himself or members The diabetic patient should also be educated in respect
of his immediate environment, if the patient is in need of to lifestyle changes that are crucial in the prevention and
assistance and cannot perform the tasks alone either due to management of the diabetic foot syndrome18.
complications of the disease, e.g. poor eyesight, or due to
other factors, e.g. age, chronic diseases. Physical exercise
Undertaking physical exercise in order to achieve weight
Annual foot examination
management is very important to the diabetic patient, since
According to the American Diabetes Association, all a very high percentage of diabetics are overweight. Moderate
patients with diabetes require an annual foot screening13 daily exercise of less than 30 minutes improves the insulin
in order to identify high risk conditions of the foot such as sensitivity and lowers the blood pressure19.
foot deformities or callus formation as well as help with
the management of problems with the feet. There is ample Smoking
evidence to suggest that the annual foot examination helps Smoking is not only a well documented health risk in
in the reduction of foot ulceration as well as in the number of connection with lung cancer but also a factor for peripheral
lower limb amputations, and the diabetic patients should be vascular disease, and as a result a leading cause for the
encouraged to make regular follow up visits. development of ulcers20.
Self-care inspection and hygiene Glucose control
The diabetic patients should be educated as to how to Regular screening of hyperglycemia is vital for the
properly inspect their feet in order to note any early sign of prevention of neuropathy, one of the main causes of diabetic
abnormality. The patients should be instructed to daily check foot syndrome. Hyperglycemia can affect the immune system
both the plantar and the dorsal aspects of their feet, the causing delay in the healing of wounds21. Studies have shown
heels and the areas between the toes. If not able, they could that glucose control could help reduce nerve damage by
use a mirror to help inspect their feet or ask a member of 60% as well as several other vascular complications22.
their environment for help. Any swelling, change in the color
or break in the skin of the feet as well as any wound that does Lipid and blood pressure control
not heal should be treated as a sign to seek medical advice14. According to the American Diabetes Association, there
Hygiene also plays a very important role. The patients is a reduced risk of vascular complications through lipid and
should be encouraged to wash their feet daily and dry blood pressure control23. A nurse can explain these facts in
them thoroughly, particularly the area between the toes. simple terms making suggestions for screening and dietary
The application of moisturising and non-irritant foot cream choices involving low cholesterol foods.

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Discussion
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