# Situation: The public health nurse makes follow-up home visits to adults enrolled in the barangay registry for hypertension and diabetes. A 67-year-old woman with diabetes has reduced feeling in both feet. Which self-care practice should the nurse teach her?

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> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The public health nurse makes follow-up home visits to adults enrolled in the barangay registry for hypertension and diabetes.

A 67-year-old woman with diabetes has reduced feeling in both feet. Which self-care practice should the nurse teach her?

## 보기

1. Trim the toenails in a curve along the toe tip
2. Check the soles every day using a hand mirror **✔ 정답**
3. Walk barefoot at home so the feet stay dry
4. Soak the feet in warm water for 20 minutes daily

**정답: 2**

## 해설

Reduced sensation means injuries go unnoticed and can progress to ulcers, infection, and amputation. Daily foot inspection, including the soles with a mirror, is a core part of diabetes self-care, together with lukewarm washing, cutting nails straight across, and never going barefoot.

## 심화 해설

Why daily foot inspection is the priority

Reduced sensation in both feet indicates peripheral sensory neuropathy, a common complication of long-standing diabetes. When protective sensation is lost, minor trauma such as a small cut, blister, or pressure point from footwear is not felt. Because the person does not notice the injury, it can progress silently into a diabetic foot ulcer, then infection, and potentially amputation. The most important self-care action is therefore early detection through daily visual inspection.

Checking the soles every day using a hand mirror allows the patient to see areas that are not visible when looking straight down. The plantar surface is a high-risk zone because it bears weight and is often the first place ulcers form. A mirror is especially helpful for older adults who may have limited flexibility or vision changes.

Key point! Daily foot inspection is not a single isolated task. It works best when combined with washing the feet in lukewarm water, drying carefully between the toes, applying moisturizer to dry skin but not between the toes, and wearing well-fitting shoes and socks at all times.

Why the other options are unsafe

| Option | Problem |
| --- | --- |
| 1. Trim toenails in a curve | Curved trimming follows the toe shape and can cause ingrown toenails or small cuts. With reduced sensation, these injuries may go unnoticed and become infected. Nails should be cut straight across and filed smooth. |
| 3. Walk barefoot at home | Walking barefoot removes the protective barrier of shoes and socks. Even indoors, a sharp object, rough surface, or hot floor can injure an insensate foot without the person realizing it. People with diabetic neuropathy should never walk barefoot, even at home. |
| 4. Soak feet in warm water for 20 minutes daily | Prolonged soaking softens and macerates the skin, making it more fragile and prone to breakdown. It also does not improve sensation or prevent ulcers. Feet should be washed briefly in lukewarm water, never hot, because neuropathy can impair temperature perception and lead to burns. |

What the evidence adds

A systematic review on preventing foot ulcers in at-risk patients with diabetes emphasizes that prevention must target modifiable risk factors, and patient self-care education is a core component of any prevention strategy [1]. The review highlights that simply giving general advice is not enough; structured education that includes daily foot inspection and appropriate footwear is more effective.

A meta-analysis of educational interventions for diabetes-related foot disease found that structured education programs can improve foot-care knowledge and self-care behaviors, which are intermediate steps toward reducing ulcer risk [2]. The evidence supports teaching specific, observable behaviors such as using a mirror to inspect the soles, rather than relying on vague instructions to “check your feet.”

A Cochrane review on patient education for preventing diabetic foot ulceration notes that education alone has not consistently shown a direct reduction in ulcer incidence in all trials, but it remains a recommended component of care because it addresses the practical skills patients need for early detection [3]. The review also reinforces that education should be combined with regular professional foot assessment and appropriate footwear.

Watch out! In a test scenario, any option that involves cutting nails in a curve, going barefoot, or soaking the feet is a red flag for unsafe practice in a patient with reduced sensation. The correct answer is always the option that promotes early detection and protection of the foot.References (research sources)

- [1]Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review.Meta-analysis/systematic reviewvan Netten JJ, Price PE, Lavery LA, Monteiro-Soares M, Rasmussen A, Jubiz Y (2016) · DOI: 10.1002/dmrr.2701

- [2]Effectiveness of educational interventions for diabetes-related foot disease: A systematic review and meta-analysis.Meta-analysis/systematic reviewDrovandi A, Seng L, Golledge J (2024) · DOI: 10.1002/dmrr.3746

- [3]Patient education for preventing diabetic foot ulcerationResearch articleJohannes A N Dorresteijn, Didi M. W. Kriegsman, Willem JJ Assendelft, Gerlof Dirk Valk (2012) · DOI: 10.1002/14651858.cd001488.pub4

## 임상 시나리오

Diabetic Neuropathy Foot InspectionDaily mirror check for early ulcer detection
In peripheral sensory neuropathy, pain is absent, so minor trauma progresses silently. Teach the patient to inspect the plantar surface daily using a hand mirror to see areas not visible when looking down.

Inspection works best as part of a full routine: wash feet in lukewarm water, dry carefully between the toes, moisturize dry skin but not between the toes, and always wear well-fitting shoes and socks.

CautionNever recommend barefoot walking, soaking, or curved toenail trimming. These practices cause unnoticed injury or skin maceration, increasing ulcer and infection risk in the insensate foot.

## 핵심 개념

- **Peripheral sensory neuropathy** — Loss of protective sensation in the extremities, a common diabetes complication that allows minor trauma to go unnoticed and progress to ulcers.
- **Diabetic foot ulcer** — A full-thickness wound on the foot of a person with diabetes, often starting from unnoticed minor trauma and carrying high risk of infection and amputation.
- **Plantar surface** — The sole of the foot, a high-risk area for ulcer formation due to weight-bearing pressure and difficulty with self-inspection.
- **Ingrown toenail** — A condition where the nail edge grows into the surrounding skin, often caused by curved trimming, and a preventable source of infection in neuropathy.
- **Macerated skin** — Softened, over-hydrated skin from prolonged moisture exposure, which is more fragile and prone to breakdown and infection.

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