Evaluation of foot care knowledge and practices in diabetic patients with painful peripheral neuropathy

Diabetic foot ulcers can cause mortal conditions such as loss of limbs and sepsis due to progression of infection if precautions are not taken, therefore foot care is very important in diabetic individuals. The aim of this study is to evaluate the effect of the presence of painful peripheral neuropathy on foot care knowledge and practices in diabetic patients and to determine whether there is a correlation between the severity of neuropathic pain and current foot care knowledge and practices. A total of 140 patients who applied to the Internal Medicine Polyclinic for routine control and follow-up with a diagnosis of Type 2 DM between 08/01/2024 and 08/07/2024 and agreed to participate in the study were included in our study. Routine medical history was taken from all patients, system-complaint inquiry and physical examination were followed by laboratory tests requested in routine controls. All patients were screened for painful neuropathy using the DN4 questionnaire together with anamnesis, physical examination. Nottingham assessment of functional foot care and the Diabetes Foot Self-Care Behavior Scale questionnaires measuring foot care knowledge and practices were applied to both patient groups. The study data were analyzed with SPSS 25.0 program. The NAFF and DÖAD scale scores, sociodemographic and laboratory data of both groups with and without painful neuropathy were compared with descriptive statistical analysis methods. The relationship between the NAFF and DAÖD scale scores and the variables was examined separately in the two groups with correlation analysis. Univariate tests and independent variables that were significant in the correlation analysis were included in linear and binary logistic regression (BLR) analysis. Those who scored 26x2 points = 52 and above from the NAFF scale were considered to have adequate foot care. Significant variables were shown in the tables as a result of the analysis. In the analyses, p<0.05 results were considered statistically significant. The groups were similar in terms of gender, age, education level, employment status, marital status, duration of diabetes, weekly exercise duration, type of treatment received, and known neuropathy and nephropathy in those with and without painful neuropathy (p>0.05). Diagnosed diabetic retinopathy and coronary artery disease were more common in those with painful neuropathy than in those without (p<0.05). The NAFF score of the group with painful neuropathy was 45.2±8.2, the DAÖD scale score was 22.2±9.3; the NAFF score of the group without painful neuropathy was 47.9±8.9, and the DAÖD scale score was 23.2±8.6. Although the foot care knowledge level determined by the NAFF scale was higher in the group without painful neuropathy, no statistically significant difference was found between the groups (p=0.06). The rate of those who received sufficient scores from the NAFF scale in the study group was 33.6%. According to NAFF, the status of having sufficient foot care knowledge was 2 times higher in those without painful neuropathy than in those with painful neuropathy, and this was found to be correlated with the increase in the level of education (p<0.05). No correlation was found between the DN4 score indicating the severity of painful complaints in the group with painful neuropathy and the NAFF and DAÖD scale scores indicating foot care knowledge levels (r=0.05 and r=0.11). Although the level of foot care knowledge was found to be higher in the group without painful neuropathy according to the NAFF scale; there was no statistical difference between the groups with and without painful peripheral neuropathy in terms of DAÖD and NAFF mean scores. We did not find a statistically significant relationship between the severity of neuropathic pain and the level of knowledge. Our results did not reveal a correlation between the severity of neuropathic pain and foot self-care scores, but it was seen that the group without painful neuropathy had twice as sufficient foot care knowledge levels, which was correlated with the increase in the level of education. In order to reduce the risk of diabetic foot formation, patients should be followed up, evaluated and educated in this regard.