At the recent meeting of the American Diabetes Association (ADA) in San Diego (see AJN Reports, page 28), the International Diabetes Foundation described its yearlong initiative, developed in partnership with the ADA, to create awareness that frequent examinations and early treatment of lesions can prevent amputations of the foot and lower leg in patients with diabetes. Karel Bakker, chairperson of the International Working Group on the Diabetic Foot, noted that 85% of amputations followed the development of a foot ulcer and that one in six patients with diabetes will develop a foot ulcer. Reporting that only 14% of health care professionals perform foot exams at patient visits, Bakker called for foot inspections (including the inspection of footwear) at every visit, better education of patients and families (that includes instructions to perform daily inspections of feet and footwear), and rapid and aggressive treatment of all foot problems.
Andrew Bolton, a British physician, concurred, presenting information on global trends, including results achieved by some countries that have opened foot clinics and centers. One shining example was Brazil, which opened its first foot treatment clinic in 1992; the country now has 52 clinics, including the foot center in Brasilia. There, according to Bolton, the team of one physician, one nurse, and a shoemaker had achieved a 77% reduction in the number of amputations since they began. People in underdeveloped countries are at special risk for foot problems because many cannot afford shoes that fit properly or must walk barefoot, increasing their chances of foot injuries and infections.
But these problems aren't restricted to poor countries. Lawrence Lavery, a Texas surgeon, said that there are more than 90,000 lower-extremity amputations in the United States each year, half of which occur in patients with diabetes. Of special concern is the fact that 50% to 68% of these amputation patients with diabetes will have a second amputation within five years.
The sad thing, echoed by all the presenters, is that 85% of the amputations could be prevented if simple foot examinations were performed. The message for patients, Lavery says, is that "[amputation] is not an inevitable complication of diabetes, and patients can do much to make their feet last a lifetime."-Maureen Shawn Kennedy, MA, RN, news director