Methods Comprehensive foot intervention was performed on 387 diabetic patients who met the inclusion criteria and were admitted to the Department of Podiatry, Second Staff Hospital of Wuhan Iron and Steel (Group) Corporation from July 2016 to July 2017. The podiatrists screened, educated, and managed the diabetic foot high-risk group with dedicated interventions, examined the appearance of the patient′s feet, peripheral nerves, and blood vessels in the feet, and strengthened the education of foot-related knowledge to patients and their families through WeChat groups, follow-up consultations and return visits to improve the patient′s awareness of self-protection; collected relevant information from patients, established patient management files and carried out graded management of diabetic foot. The high risk factors of diabetic foot were screened, blood sugar control targets were determined and controlled within the target range according to the age and basic condition of patients, regulated the patient′s blood pressure and blood lipids, quit smoking, and appropriate diet, exercise and lifestyle programs were formulated for patients. Based on the above, the patients were given a 1-year intervention, and those patients with foot diseases detected by screening were given early treatment and preventive measures. The abnormal foot appearance (tinea pedis, onychomycosis, callus, corns and foot deformities), peripheral nerves (touch, temperature, vibration, pain, Achilles tendon reflex) and peripheral vascular conditions (skin temperature, dorsalis pedis artery pulsation, posterior tibial artery pulsation, foot edema, foot bruising, foot ulcers and foot numbness or pain) were examined and recorded at the time of admission and every month during the 1-year period of the comprehensive foot intervention, and the above indices were compared between the patients at the time of admission and at the time of the last examination 1 year after the comprehensive foot intervention. Data were compared with chi-square test.
Results At the last examination, the incidences of tinea pedis, onychomycosis, and callus on the patient′s foot were 35.66% (138/387), 59.17% (229/387), and 24.81% (96/387), respectively, all significantly lower than those at admission [77.52% (300/387), 72.35% (280/387), and 53.23% (206/387)], the differences were statistically significant (χ2=138.081, 14.974, 65.754; P<0.05); at the last examination, the incidences of abnormalities in the 10 g nylon wire tactile, temperature, vibration, pain, and achilles tendon reflex examinations in the patients′ peripheral nerve examination results were 14.47% (56/387), 37.73% (146/387), 13.70% (53/387), 14.47% (56/387) and 17.05% (66/387), which were significantly lower than those at admission [60.72% (235/387), 81.91% (317/387), 29.20% (113/387), 40.31% (156/387), 42.64% (165/387)], the differences were statistically significant (χ2=176.503, 157.235, 27.658, 65.015, 60.530; P<0.05); the incidences of skin temperature changes, abnormal dorsalis pedis artery pulsation, abnormal posterior tibial artery pulsation, foot edema, foot bruising and foot numbness or pain in the patients′ peripheral foot vascular findings at the last examination were 12.40% ( 48/387), 28.17% (109/387), 34.11% (132/387), 28.94% (112/387), 30.23% (117/387) and 11.11%(43/387), respectively, which were significantly lower than those at admission [32.30% (125/387), 64.345% (249/387), 62.53% (242/387), 77.00% (298/387), 78.30% (303/387), 17.83%(69/387)], the differences were statistically significant (χ2=44.188, 101.918, 62.655, 118.143, 180.159, 7.106; P<0.05), while the incidences of foot ulcers in patients at the last examination was 6.72% (26/387), which was lower than [9.82% (38/387)] at admission, the difference was not statistically significant(P>0.05).
Conclusion Comprehensive interventions by podiatrists can further prevent diabetic foot ulcers by safely and effectively reducing the incidence of tinea pedis, onychomycosis, and callus as well as reducing the incidence of abnormal results of items related to peripheral nerve and peripheral vascular examinations of the foot, thereby delaying damage to diabetic patients from high-risk factors of the diabetic foot.