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Fragile Feet and Trivial Trauma: Communicating the Etiology of Diabetic Foot Ulcers to Patients
Örebro University Hospital. Örebro University, School of Health Sciences. Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.ORCID iD: 0000-0002-6410-2474
Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Academic Medical Center, Amsterdam, the Netherlands; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia; Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia.
2023 (English)In: Journal of the American Podiatric Medical Association (Print), ISSN 8750-7315, E-ISSN 1930-8264, Vol. 113, no 1, article id 21-027Article in journal (Refereed) Published
Abstract [en]

People at risk for diabetic foot ulcer (DFU) often misunderstand why foot ulcers develop and what self-care strategies may help prevent them. The etiology of DFU is complex and difficult to communicate to patients, which may hinder effective self-care. Thus, we propose a simplified model of DFU etiology and prevention to aid communication with patients. The Fragile Feet & Trivial Trauma model focuses on two broad sets of risk factors: predisposing and precipitating. Predisposing risk factors (eg, neuropathy, angiopathy, and foot deformity) are usually lifelong and result in "fragile feet." Precipitating risk factors are usually different forms of everyday trauma (eg, mechanical, thermal, and chemical) and can be summarized as "trivial trauma." We suggest that the clinician consider discussing this model with their patient in three steps: 1) explain how a patient's specific predisposing risk factors result in fragile feet for the rest of life, 2) explain how specific risk factors in a patient's environment can be the trivial trauma that triggers development of a DFU, and 3) discuss and agree on with the patient measures to reduce the fragility of the feet (eg, vascular surgery) and prevent trivial trauma (eg, wear therapeutic footwear). By this, the model supports the communication of two essential messages: that patients may have a lifelong risk of ulceration but that there are health-care interventions and self-care practices that can reduce these risks. The Fragile Feet & Trivial Trauma model is a promising tool for aiding communication of foot ulcer etiology to patients. Future studies should investigate whether using the model results in improved patient understanding and self-care and, in turn, contributes to lower ulceration rates.

Place, publisher, year, edition, pages
American Podiatric Medical Association , 2023. Vol. 113, no 1, article id 21-027
National Category
Endocrinology and Diabetes Nursing
Identifiers
URN: urn:nbn:se:oru:diva-104891DOI: 10.7547/21-027ISI: 001112027400002PubMedID: 36905618Scopus ID: 2-s2.0-85150225601OAI: oai:DiVA.org:oru-104891DiVA, id: diva2:1742904
Available from: 2023-03-13 Created: 2023-03-13 Last updated: 2024-01-22Bibliographically approved

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