Risk Factors and Prevention of Diabetic Foot Ulcer: A Cross-Sectional Survey of Healthcare Practitioners in a South African Setting

Background/Objective: Prevention of foot ulceration is critical to reduce the rate of amputation in individuals with diabetes mellitus (DM). We investigated knowledge of risk factors and prevention of diabetic foot ulcer (DFU) among healthcare practitioners (HCPs). Methods: This was a prospective cross-sectional observational study using a self-administered questionnaire. Participants were HCPs involved in management of patients with DM. The questionnaire investigated professional background, prior education, knowledge of risk factors DFU, foot care and appropriate footwear. Participants were asked to indicate if they agreed or disagree with a statement. Scores were based on percentage response by each category of HCPs. Knowledge level was classified as very poor if less than 50% of participants from a category of HCPs answered appropriately, reasonable for 50%-59%, average at 60%-69%, above average from 70%-79% and excellent when ≥80%. The chi-square test to compare the knowledge levels across the categories of HCPs. Results: 449 HCPs participated and 48.1% (216/449) were therapeutic health practitioners (THPs), 37.4% (168/449) nurses and 14.5% (65/449) medical doctors. 36% (162/449) of participants had prior education on DFU. Overall knowledge level among participants of risk factors of DFU was 80%, appropriate technique of foot examination 80%, identification of limb-threatening conditions 82%, proper foot care 77% and selection of appropriate footwear 65%. Differences in knowledge levels across HPCs was statistically significant (P <0.05). Conclusion: Majority of HCPs had no prior education on prevention of DFU. The level of knowledge regarding foot care, risk factors and prevention of DFU among HCPs was mostly insufficient.