Most nontraumatic lower limb amputations in the United States are diabetes related. Adjusting for age, the 1997 lower extremity amputation rate for persons with diabetes was 28 times greater than for persons without diabetes. Hispanic Americans are 1.9 times more likely to have diabetes than non-Hispanic whites of similar age. Comprehensive foot care programs can significantly reduce amputation rates. In 2001, only 54.7% of Hispanic Americans reported having an annual foot examination compared to 61.4% of non-Hispanic whites and the Healthy People 2010 objective (5-14) of 75%.
A community, faith based organization (CFBO), serving a low-income, primarily Hispanic population, provides a variety of services, including an all-volunteer staffed health clinic. During a clinic targeted toward people with or at risk for diabetes, the attending physician noted that many patients needed follow-up foot care. Through a partnership with the CFBO, a community health nursing faculty and team of five senior-level baccalaureate nursing students designed a foot clinic to meet the needs of this population. The foot clinic plan was based on materials from the “Feet Can Last a Lifetime” campaign of the National Diabetic Education Program and Task Force on Community Preventive Services guidelines. The clinic, customized to meet the needs of low income Hispanics with limited English literacy skills, utilized an all-volunteer staff. Specific interventions were education and practice in nail care, foot care, cleaning, and daily examination; clinical examination by the podiatrist; and provision of appropriate supplies for foot care at home. A guide including planning timeline, forms, descriptions of stations, objectives, and signage was developed so that the program could be evaluated and replicated.
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