Foot care practices, services and beneficiaries with diabetes at high perceptions of risk among Medicare and low risk for future foot complications

A cohort of Medicare beneficiaries with diabetes was identified from inpati ent and outpatient claims data and their risk for foot complications was es timated based on claims reflecting services for recent foot problems. A tel ephone survey of a random sample from this cohort was conducted to assess t heir foot care practices, barriers, and perceptions of risk. Eight percent of respondents reported a history of foot ulcers and 7% a history of lower extremity amputation. Based on claims data, 30% of respondents were at high risk for future foot complications. Compared to those at low risk, those a t high risk were more likely to report having an annual foot exam, using pr otective footwear, and perceiving themselves to be high risk for future foo t complications. However, 50% of those with claims indicating a high risk p erceived themselves to be at low risk for future foot complications. Overal l, 20% of respondents seldom checked their feet daily for sores or irritati ons. Among this group, 60% felt that it was unimportant and 9% reported the y were limited by poor vision or physical problems. Our findings suggest th at strategies are needed to improve the delivery of preventive foot care se rvices to older persons with diabetes. Additionally, emphasis is needed to help individuals understand their risk and seek and perform appropriate pre ventive foot care.