4.4.0.0 Pa­tient Ed­u­ca­tion

All pa­tients with di­a­betes and par­tic­u­larly those with high-‍risk foot con­di­tions (his­to­ry of ulcer or am­pu­ta­tion, de­for­mi­ty, LOPS, or PAD) and their fam­i­lies should be pro­vided gen­er­al ed­u­ca­tion about risk fac­tors and ap­pro­pri­ate man­age­ment (146). Pa­tients at risk should un­der­stand the im­pli­ca­tions of foot de­for­mi­ties, LOPS, and PAD; the prop­er care of the foot, in­clud­ing nail and skin care; and the im­por­tance of foot mon­i­toring on a daily basis. Pa­tients with LOPS should be ed­u­cated on ways to sub­sti­tute other sen­so­ry modal­i­ties (pal­pa­tion or vi­su­al in­spec­tion using an un­break­able mir­ror) for surveil­lance of early foot prob­lems.

The se­lec­tion of ap­pro­pri­ate footwear and footwear be­hav­iors at home should also be dis­cussed. Pa­tients’ un­der­stand­ing of these is­sues and their phys­i­cal abil­i­ty to con­duct prop­er foot surveil­lance and care should be as­sessed. Pa­tients with vi­su­al difficul­ties, phys­i­cal con­straints pre­venting move­ment, or cog­ni­tive prob­lems that im­pair their abil­i­ty to as­sess the con­di­tion of the foot and to in­sti­tute ap­pro­pri­ate re­sponses will need other peo­ple, such as fam­i­ly mem­bers, to as­sist with their care.