Fragile Feet and Trivial Trauma: Communicating the Etiology of Diabetic Foot Ulcers to Patients @JAPMAfeettweets

Our toemigos Gustav Jarl, Jaap van Netten, and Peter Lazzarini with another important contribution

1. Patients with a high risk for diabetic foot ulcers often have a limited understanding of the complex etiology of the condition, which can hinder effective self-care.
2. The Fragile Feet & Trivial Trauma model proposes a simplified approach to explain the risk factors for foot ulcers to patients, focusing on predisposing and precipitating risk factors.
3. The model aims to aid communication with patients about their lifelong risk of foot ulcers, while also emphasizing the importance of healthcare interventions and self-care practices to reduce these risks. Future studies should investigate whether the model can improve patient understanding and contribute to lower ulceration rates.

People at risk for diabetic foot ulcer (DFU) often misunderstand why foot ulcers develop and what self-care strategies may help prevent them. The etiology of DFU is complex and difficult to communicate to patients, which may hinder effective self-care. Thus, we propose a simplified model of DFU etiology and prevention to aid communication with patients. The Fragile Feet & Trivial Trauma model focuses on two broad sets of risk factors: predisposing and precipitating. Predisposing risk factors (eg, neuropathy, angiopathy, and foot deformity) are usually lifelong and result in “fragile feet.” Precipitating risk factors are usually different forms of everyday trauma (eg, mechanical, thermal, and chemical) and can be summarized as “trivial trauma.” We suggest that the clinician consider discussing this model with their patient in three steps: 1) explain how a patient’s specific predisposing risk factors result in fragile feet for the rest of life, 2) explain how specific risk factors in a patient’s environment can be the trivial trauma that triggers development of a DFU, and 3) discuss and agree on with the patient measures to reduce the fragility of the feet (eg, vascular surgery) and prevent trivial trauma (eg, wear therapeutic footwear). By this, the model supports the communication of two essential messages: that patients may have a lifelong risk of ulceration but that there are health-care interventions and self-care practices that can reduce these risks. The Fragile Feet & Trivial Trauma model is a promising tool for aiding communication of foot ulcer etiology to patients. Future studies should investigate whether using the model results in improved patient understanding and self-care and, in turn, contributes to lower ulceration rates.