Foot ulcers should be the most preventable complication of diabetes.

Simple foot problems such as calluses or dry cracked skin can often lead to more serious complications. However these easily treatable problems can often be overlooked as there is little support available to guide people to undertake regular foot self-care, so they know how to care for their feet, know what to look for and what they should do and who to contact if they were worried about a potential complication.

A recent study has highlighted how 80% of nurses surveyed did not feel confident in how, and why, they were performing the tests included in a foot screening examination. If the health care professionals (HCPs) themselves are not sufficiently trained and supported to undertake the basic foot screening tests how can they adequately guide or involve their patients in decision-making with regard to their foot care?

If people do receive education it tends to be rooted in a traditional approach to information delivery rather than engagement.  I would argue that person-centred guidance should be made available to all people with diabetes early on in their illness. Support should focus on helping people to integrate foot care into their general self-management regimes and during all subsequent appointments with HCPs. The reality is that people who are currently considered to be at low risk of developing diabetes-related foot complications may receive little if any information or support to enable them to undertake foot-self care.

Given the significant morbidity associated with foot ulcers, successful preventative care should begin with interventions designed to prevent their occurrence in the first place and incorporate not only information dissemination but also strategies to facilitate foot self-care. We also need to move away from labelling diabetes related foot complications as  ‘diabetic foot disease’ or the ‘diabetic foot’.

In the traditional medical model, disease is the diabetic foot. We need however to treat more than just the injury or lesion, we need to consider the whole person; the dynamic between neurological and vascular changes, skin integrity, the person’s psychological states, with emotions such as fear, uncertainty, apathy and guilt, the burden of daily diabetes management, family pressures and the knowledge of others with complications.

So often people with diabetes are judged by as being ‘non-compliant’  and this can lead to negative value judgements. What is overlooked is that they are living the best they can with a relentless illness and some days they may cope better than others. It is therefore important to reconcile the clinical view of a situation with the person’s experience of illness to achieve a truly person-centred relationship.

Almost 50 years ago the psychoanalyst Enid Balint published a paper calling for another way of medical thinking and suggested that the prime aim of a scientific medical examination should not be just to identify a fault within the body, diagnose and then treat it, but that the doctor should also examine the whole person to form an “overall diagnosis” and understand the patient as a “unique human being”.

As humans we are fortunate to have the unique and expressive power of language, but as healthcare professionals the way we use those words is incredibly important as highlighted by recent NHS  guidance document Language Matters.

Much more needs to be done to improve the care people receive with regards to their foot health – a start would be to consider the whole person rather than just the “diabetic foot”.

FeelYourFeet – Connecting • Listening • Sharing

#Languagematters #Personalisedcare #FeelYourFeet #Podiatry #Diabetes #Diabetescomplications

 

 

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