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Risk assessment

Risk assessment could protect the feet of diabetes patients

A stringently designed web form with questions about foot ulcers, deformities and neuropathy will soon be brought into use to better protect the feet of people with diabetes, according to researchers from the Sahlgrenska Academy.

A stringently designed web form with questions about foot ulcers, deformities and neuropathy will soon be brought into use to better protect the feet of people with diabetes, according to researchers from the Sahlgrenska Academy.

"One of the reasons why patients in the risk zone are not detected in time is that there is no standardised procedure of foot examination which means risk assessment is subjective," said Dr Ulla Hellstrand Tang, a certified prosthetist and orthotist with long experience in the care of diabetes patients with feet problems. "Foot ulcers are a common cause of amputation for people with diabetes. The National Board of Health and Welfare recommends diabetics to have their feet checked but routines are inadequate and there are large regional differences.”

In her research, Hellstrand Tang has now developed a simple, standardised e-health tool for the risk assessment of feet. Clear descriptions and pictures guide the person through the 22 self-examination steps so there can be no uncertainty about the patient's status.

The patient is asked questions about, for example, mobility, foot ulcers, numbness and degree of perspiration. Reduced foot perspiration may indicate a nerve injury. Likewise, the presence of a bunion (hallux valgus), hammer toe or other deformity is examined, and so on.

All the question variables have been scientifically tested so that a certain condition is always given the same classification and treatment recommendation.

Later in 2017, Sahlgrenska University Hospital in Gothenburg, Sweden will start to use the D-Foot tool and it is hoped that other clinics will do the same.

"I am very pleased that the tool is being taken into use so soon and can thereby help patients," she added.

She has also investigated which aids best protect patients' feet from unnecessarily high pressure. In a two-year study, about a hundred patients tested both prefabricated and individually designed insoles. Pressure was measured regularly at seven different measuring points under the feet. The heels were subjected to the strongest pressure.

"It was shown that a personally designed insole gives a closer fit around the heel cushion, provides support to a larger area, and reduces pressure significantly more than a traditional, prefabricated insole does," she explained. “However, we could also see that combinations of good shoes and prefabricated insoles created good support and acceptable pressure for some people. A patient whose feet are in relatively good shape can begin by using a cheaper and simpler insole. The advantage of this is that the patient's treatment is completed after just one visit and no return appointment after two-three weeks is necessary."