Barriers to diabetic foot care - A review of the literature

Purpose Identification of barriers to diabetic foot care.

Methodology.
         Search of indexed databases. 25 articles reviewed using Garrard matrix method.

Background.
         The incidence of diabetes is increasing at an alarming rate. It is estimated that one in ten people will be diabetic by the year 2035. Due to lack of sensation and decreased blood flow caused by the disease process, foot ulcers are common. A diabetic foot ulcer precedes eighty-four percent of non-traumatic, major limb amputations, and it is estimated that twenty five percent of all diabetics will have a foot ulcer.
         Amputations are expensive and have a great impact on life.  At five years post amputation mortality increases exponentially to 50-68%. The knowledge base, clinical practice guidelines and research support that many foot ulcers can be avoided with accurate assessment, education, proper foot care, appropriate foot wear, early detection and multidisciplinary treatment. However, there are barriers that hamper implementing diabetic foot care and foot ulcer prevention programs.

Results
         There are barriers to diabetic foot care on several levels.  Patients may not be physically or emotionally able to care for their feet, or may lack knowledge or financial resources for foot care. Providers may not have the time, education base or resources available to provide assessments and care. Providers also face systems barriers that hamper referrals, follow-ups and compensation. There are also barriers to be found in the health care system itself. All told, these barriers are hurdles to patients receiving timely, appropriate preventative foot care.

Conclusion
         Diabetic feet are at risk for diabetic foot ulcers. Preventative diabetic foot care is an effective method of reducing diabetic foot ulcers. Barriers to diabetic foot care exist at multiple levels. Understanding the barriers may help health care providers; patients and policy makers shift resources towards supporting preventative foot care.