Aim: Diabetic foot self-care activities are often less than optimal and clinicians may find themselves unable to influence them in a positive direction. The aim was to present a novel framework, the process perspective on the diabetic foot, which can explain inadequate self-care behaviors and how they can be improved.
Methods: A literature analysis was conducted.
Results: The central principle of the process perspective is that diabetic foot disease is not a dichotomy (treatment and prevention) but a process over time, including alternating phases of active and latent diabetic foot disease (Fig. 1a). Thus, the patient is standing in the midst of a process, with a history of experiences and expectations for the future, all relevant to the patient’s current self-care behavior. A fictive patient case illustrates how the process perspective can be used to understand patients’ situation and how beliefs and behaviors are sometimes self-reinforcing, resulting in stable behavior patterns (‘diabetic foot cycles’), which are difficult to understand from a dichotomous perspective. The process perspective can be used to analyze ‘vicious’ diabetic foot cycles (Fig. 1b) of inadequate patient behavior and to find ways to transform them into ‘virtuous’ diabetic foot cycles (Fig. 1c), resulting in effective prevention and treatment.
Conclusions: The process perspective on the diabetic foot seems suitable for understanding inadequate patient behaviors not easily understood with a dichotomous perspective, opening up new avenues for clinical practice and research to help patients live a life with long remission phases, few relapses, and a high quality of life.