Psychosocial and educational implications of diabetic foot complications

Abstract

In recent years, clinicians have begun to recognize the impact that educational, psychosocial, and behavioral factors have on treatment success for leg and foot wounds. Further, many now consider quality of life an important outcome of treatment for those suffering from neuropathy, foot ulcerations, and amputations. However, although interest is increasing, behavioral aspects of the diabetic foot remain emerging science. Researchers are only now beginning to investigate the psychological response to diabetic foot ulceration and amputation and the behavioral and psychological factors that influence self-care. Although cross-sectional studies have explored these areas, little longitudinal data currently exist. In this chapter, we review the current state of behavioral science pertaining to individuals with diabetic foot disease including barriers to prevention, precipitating factors, and therapeutic interventions. The first section describes some of the behavioral/psychological issues faced by individuals with diabetes during the course of their illness. We describe four phases of psychological responses and attempt to relate these phases to the prevention, diagnosis, or treatment of foot problems. Then, we discuss quality of life for those with peripheral neuropathy, lower extremity wounds, or amputations. Next, we discuss depression, its impact on selfcare, signs and symptoms, and implications of treatment. Finally, we describe measurement instruments, strategies, and interventions that may be useful for clinicians either to incorporate into their clinical practice or as a referral for struggling patients.