Framework: The Chronic Disease Model defines outcomes based on the patient, healthcare system, and support systems. Incidence of foot wounds with diabetes is approximately 15% with 7 per 1,000 progressing to amputation/year at $30,000 each. Reduced productivity and quality of life are significant with wounds or amputation.

 Research Design: An experimental randomized, controlled design enrolled 128 adults with diabetes for 1 year who were at high risk or very high risk for foot wounds. Dependent variables were: lesion rates, health status, and healthcare costs. Treatment was well-foot care (nails trimmed, calluses filed, pressure off-loading, and wound care) plus education. The control group received education only. Each visit, participants received foot assessment. High-risk feet in the treatment group were seen every 3 months and very-high-risk feet were seen every 2 months. Control participants were seen every three months regardless of category. Control participants were referred to healthcare providers if needed. The Medical Outcomes Study Short Form-36 was completed at enrollment and the end of 1 year. A patient satisfaction survey was done at the end. A 1-year healthcare utilization survey was completed and times of visits were measured to calculate costs.

 Data Analysis: Z-tests, chi-square, and t-tests were used.

 Study Findings: Fewer lesions occurred on visit 1 in treatment participants than control although not statistically significant (10 vs. 13; chi square  = 0.820, p=0.636). At visit 5, 18.7% more lesions occurred in control than treatment participants (12 vs. 8, statistically significant chi square  =4.385, p=0.034). There were a mean 8.4% fewer lesions in the treatment group overall demonstrating effectiveness of nursing interventions to prevent foot wounds.