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Foot practices in patients with type 2 diabetes: Where do we stand?

Background: Diabetic foot ulcer is a major cause of morbidity, mortality, hospitalisation, poor quality of life and socio-economic burden in diabetic patients. Educating patients about foot care and improving foot care practices can help in the prevention of foot ulcer and thus reduce the rate of lower extremity amputations. Objective: The aim of this study is to evaluate the knowledge and practices regarding foot care in diabetic patients presenting with foot ulcers in a tertiary care hospital of Karachi, Pakistan. Methodology: This cross-sectional study was conducted at a specialised foot clinic of Baqai Institute of Diabetology and Endocrinology, a tertiary care hospital of Karachi, Pakistan. All patients with type 2 diabetes presenting with a history of foot ulcers were included in the study after taking informed consent. Only those patients with either already diagnosed diabetes mellitus or diagnosed in the clinic according to the American Diabetes Association diagnostic criteria were included in the study. Information regarding history, physical examination, Hba1c levels were collected in all patients through hospital HMS software. Ankle-brachial index and vibration perception threshold were done as part of foot examination in every patient. X-ray and tissue culture/sensitivity were done where indicated. The Nottingham assessment of functional foot care revised 2015 questionnaire was used to evaluate patients’ foot care knowledge and practices before presenting to our institute. The interview was conducted by a trained healthcare professional on one-to-one basis. Patients who scored >70% had good knowledge and practices of foot care, those between 50% and 70% had average and those who scored <50% had poor knowledge and practices of foot care. Results: A total of 358 patients were included in the study. Out of which 243 were male and 115 were female. The average age was 54.43 ± 11.4 years, and the mean duration of diabetes was 13.35 ± 8.30 years, and the mean HbA1c was 9.60 ± 2.30. All the patients included were of type 2 diabetes mellitus. Out of the total respondents, 153 (43.2%) respondents had never received any foot care education from any healthcare professional prior to the development of ulcer and presenting to this institute, ten (0.8%) had received some information of foot care from print or electronic media or through family and friends, whereas 191 (54%) received foot care education formally by a health care professional. Only 148 (41.6%) got their feet examined by some healthcare professional before developing foot ulcer, while 196 (55.1%) never got their feet examined before presenting to this institute. Overall, 7% of the study participants had good foot care knowledge and practices, 55.3% had average and 37.7% had poor foot care knowledge and practices. Conclusion: Knowledge and practices of foot care were found to be unsatisfactory in most of the patients. This is of utmost importance to introduce foot care education programs at primary as well as tertiary care level with regular periodic physician reinforcement to reduce the incidence of diabetic foot ulceration and amputations.