The devil is in the detail: Prevention of diabetic foot ulceration in rural area is possible

Abstract

Background: Foot self-care capability is an important factor in diabetic foot ulceration, especially in disadvantaged rural areas. Aim: To explore the causes of foot ulceration and practice foot self-care behaviors before and after diabetic foot ulceration. Method: A descriptive, retrospective design was conducted in a rural hospital in southern Taiwan. Results: A total of 49 participants with diabetic foot ulcers participated in this study. More than half were male (63.3%), still working in farming or fishing (61.2%). All participants were suffering from peripheral neuropathy (100%) and 71.5% showed claudication. Nearly two thirds reported not having received diabetic foot care education and 82% not having received regular vasculopathy assessment before the wound appeared. The common reasons for foot ulcers were unnoticed trauma, neglect of foot self-care. Conclusions: Most diabetic foot ulcers are preventable, since they result from a high prevalence of peripheral neuropathy, inadequate provision of vasculopathy assessment and inappropriate management of foot self-care. Community health nurses can focus care toward screen regularly for early diabetic foot problems.

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Lee, C. , Chang, C. , Chen, C. , Lai, L. , Chang, C. and Chen, M. (2013) The devil is in the detail: Prevention of diabetic foot ulceration in rural area is possible. Open Journal of Nursing, 3, 257-264. doi: 10.4236/ojn.2013.32035.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Boulton, A.J.M., Vileikyte, L., Ragnarson-Tennvall, G. and Apelqvist, J. (2005) The global burden of diabetic foot disease. Lancet, 366, 1719-1724. doi:10.1016/S0140-6736(05)67698-2
[2] Bowering, C.K. (2001) Diabetic foot ulcers: Pathophysiology, assessment, and therapy. Canadian Family Physician, 47, 1007-1016.
[3] Clair, D. (2011) Diabetic foot ulcers: Assessment and education. Long-Term Living: For the Continuing Care Professional, 60, 20-22.
[4] Doobay, A.V. and Anand, S.S. (2005) Sensitivity and specificity of the ankle-brachial index to predict future cardiovascular outcomes: A systematic review. Arteriosclerosis, Thrombosis, and Vascular Biology, 25, 1463- 1469. doi:10.1161/01.ATV.0000168911.78624.b7
[5] Alzamora, M., Fores, R. and Baena-Diez, J. (2010) The peripheral arterial disease study: Prevalence and risk factors in the general population. BMC Public Health, 10, 38. doi:10.1186/1471-2458-10-38
[6] Department of Health (DOH), Executive Yuan, Taiwan (2012) Cause of death statistics: In statistics and publications. http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?
now_fod_list_no=12336&class_no=440&level_no=4
[7] World Health Organization (WHO) (2012) World health statistics, World Health Organization, Geneva. http://www.who.int/gho/publications/world_health_statistics/en/index.html
[8] Singh, N., Armstrong, D.G. and Lipsky, B.A. (2005) Preventing foot ulcers in patients with diabetes. Journal of American Medical Association, 293, 217-228. doi:10.1001/jama.293.2.217
[9] Manderbacka, K., Peltonen, R., Koskinen, S. and Martikainen, P. (2011) The burden of diabetes mortality in Finland 1988-2007—A brief report. BMC Public Health, 11, 747. doi:10.1186/1471-2458-11-747
[10] Chandalia, H.B., Singh, D., Kapoor, V., Chandalia, S.H. and Lamba, P.S. (2008) Footwear and foot care knowledge as risk factors for foot problems in Indian diabetics. International Journal of Diabetes in Developing Countries, 28, 109-113. doi:10.4103/0973-3930.45269
[11] Fujiwara, Y., Kishida, K., Terao, M., Takahara, M. and Matsuhisa, M. (2011) Beneficial effects of foot care nursing for people with diabetes mellitus: An uncontrolled before and after intervention study. Journal of Advanced Nursing, 67, 1952-1962. doi:10.1111/j.1365-2648.2011.05640.x
[12] American Diabetes Association (ADA) (2008) Standards of medical care in diabetes. Diabetes Care, 32, S62-S63.
[13] Shaw, M., Savoye, M. and Cali, A. (2009) Effect of a successful intensive lifestyle program on insulin sensitivity and glucose tolerance in obese youth. Diabetes Care, 32, 45-47. doi:10.2337/dc08-0808
[14] Bureau of Health Promotion (BHP), Department of Health, Taiwan (2011) Adult and elderly health. http://www.bhp.doh.gov.tw/BHPNet/English/Class.aspx?
Sub=publications&No=200705180041
[15] Moghtaderi, A., Bakhshipour, A. and Rashidi, H. (2006) Validation of Michigan neuropathy screening instrument for diabetic peripheral neuropathy. Clinical Neurology and Neurosurgery, 108, 477-481. doi:10.1016/j.clineuro.2005.08.003
[16] Nather, A., Chionh, S.B., Han, A.Y.Y., Chan, P.L. and Nambiar, A. (2010) Effectiveness of vacuum-assisted closure (VAC) therapy in the healing of chronic diabetic foot ulcers. Annals Academy of Medicine Singapore, 39, 353- 358.
[17] Mueller, M.J., Zou, D., Bohnert, K.L., Tuttle, L.J. and Sinacore, D.R. (2008) Plantar stresses on the neuropathic foot during barefoot walking. Physical Therapy, 88, 1375- 1384. doi:10.2522/ptj.20080011
[18] Chen, M.Y., Huang, W.C., Peng, Y.S., Guo, J.S., Chen, C.P., Jong M.C. and Lin H.C. (2011) Effectiveness of a health promotion program for farmers and fishermen with type 2 diabetes in Taiwan. Journal of Advanced Nursing, 67, 2060-2067. doi:10.1111/j.1365-2648.2011.05678.x
[19] Hiatt, W.R. (2008) Can measuring the ankle-brachial index improve public health? Journal of the American College of Cardiology, 52, 1743-1744. doi:10.1016/j.jacc.2008.08.035
[20] Arts, E.A., Landewe-Cleuren, S.A.N.T., Schaper, N.C. and Vrijhoef, H.J.M. (2012) The cost-effectiveness of substituting physicians with diabetes nurse specialists: A randomized controlled trial with 2-year follow-up. Journal of Advanced Nursing, 68, 1224-1234. doi:10.1111/j.1365-2648.2011.05797.x

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