Recent studies have demonstrated the value of foot protection programmes including education and footwear intervention. A large randomized controlled trial (RCT) demonstrated that amputation rates among people at high risk of ulcers could be significantly reduced by a foot protection program, and is cost effective (23). Patients with foot deformities, history of foot ulceration, significant vascular or neuropathic disease were randomized to the intervention, weekly clinics providing chiropody hygiene, hosiery, protective shoes and education or usual care. At 2 years the ulcer rate in the intervention group was nonsignificantly reduced, to 2.4% compared with 3.5% in the usual care group (p = 0.14). Amputations, however, were reduced threefold with 7 in the intervention group and 23 among controls (p < 0.04).
Education and podiatry may improve knowledge of foot care and in some studies have led to improvements in the condition of the feet (24). A recent review of the role of patient education in preventing diabetic foot ulceration concluded that there was poor methodology and conflicting results (25). In a prospective, randomized study (43), it was shown that the incidence of foot ulcers and amputations could be considerably reduced by use of a simple 1-hour educational program. However, weak evidence suggests that education may have positive but short-lived effects on foot care and upon the knowledge and behaviour of patients in the short term.
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