Prevention of foot problems in persons with diabetes.

Lower extremity amputations are increasing among patients with diabetes in the United States. Evidence-based reviews suggest that many of these tragic events may be preventable within the framework of existing health care services. Known benefits for high-risk patients result from the coordination of proven care strategies, such as screening, prophylactic foot care, self-care management education, and protective footwear. Organizational changes in practice settings, including provider education, team coordination, patient registries, appointment systems, flowsheets, and chart reminders, improve both patient and provider participation in the behaviors required to interrupt the cascade of events leading to amputation.