Development of a nurse-provided health system strategy for diabetic foot care.

A nurse-provided university health system diabetic foot screening/education/treatment program evaluated 403 patients in the initial 12 months of development. All patients were provided individualized foot-specific patient education, varying in intensity with the magnitude of their risk status. One hundred and forty-five (36%) were categorized as being at risk for the development of a diabetic foot ulcer. Improper footwear capable of producing foot ulceration was recorded in 268 (66.5%) of the enrollees. Seven patients with previously undiagnosed Charcot foot disorder were identified. Eighty-three of the enrollees were seen at least once in follow-up. Sixty-one (73%) used improper footwear at the initial evaluation, which was decreased to 36 (43%) at the first follow-up visit. Nurse-provided foot-specific diabetic screening and education, combined with protective footwear, has been shown to be a cost- and resource-effective method of decreasing the rate of diabetic foot ulcers, and the risk for eventual lower extremity amputation.