Improving foot exam compliance among patients with diabetes

Now considered an essential part of quality care for patients with diabetes, the clinical foot exam is a key component of preventative care. Conducting regular foot exams every six months can reduce patients with diabetes' chances of acquiring an infection that can lead to osteomyelitis or clostridial myonecrosis. Adequate foot care can also help avoid lower extremity amputation, thus preserving a patient's ability to carry out daily living activities and ensuring continued independence.

Where I work, there is a piece of paper that hangs in many of the exam rooms. It's an illustration of the plantar side of the foot with a smiley face on the first digit. Underneath of the illustration is the statement, “All diabetics please remove your socks and shoes.”

One of the national diabetes-care quality indications is conducting annual foot exams. Improving the percentage of patients with diabetes who undergo these exams is a task all providers should be striving to reach. In addition to the foot exam, patients should also be taught how to perform daily self-examinations, and referred to a podiatrist when appropriate.

Since we posted the foot exam posters in our clinic, I often enter exam rooms and encounter patients who are ready for my assessment with their socks and shoes removed. Sometimes I wonder how an illustration posted on an exam room wall can induce the utmost compliance, but when I offer personal encouragement and share my medical knowledge, it seems to have little effect on adherence.

Many of my patient with diabetes do not bother to bring a log of their blood glucose levels to our appointments, often can not remember which insulin or oral anti-hyperglycemic they are taking and, more often than not, have a half-full bottle of soda with them -- but at least they are ready for their foot exam.

While I understand the noncomplex nature the request on the foot exam poster compared with other expected diabetes interventions, I am still hopeful that the improved compliance is one small step towards helping these patients achieve a healthier lifestyle. 

Leigh Montejo, MSN, FNP-BC, provides health care to underserved populations at the Metropolitan Community Health Service's Agape Clinic in Washington, North Carolina.
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