Foot care Knowledge and Practice and prevalence of Neuropathy among people with type 2 DM

I am conducting a research study to evaluate Foot car and Practice among type 2 diabetic patients. Your
participation will involve answering some questions and your feet to be examined. Your participation, in this
study is voluntary. The results of the research study may publish but your name will not be used. This
research has been approved by The Kurdistan Board for health Specializations in Iraq
Part A: Demographic data and Health Characteristics:
1) Code :
2) Age in years:
3) Residence 1. Rural 2. Urban
4) Marital status: 1. Married 2. Single 3. Divorce 4. Widow
5) Educational level 1. Primary school (finish 6 years)
2. Intermediate (7-9) years
3. Secondary (10-12) years
4. Higher education ( more than 13) years
5. Illiterate
6. Read & Write
6) Home ownership 1. Owned 2. Rented 3. Partialowned 4. Others
7) Family income 1. sufficient 2. Not sufficient 3 > sufficient
8) Number of household members: ( )
9) Number of rooms occupied by household
Except kitchen and bathroom ( )
10) Car ownership 1. Yes 2. No
11) Occupation: 1. Un-employed 2. Unskilled manual
3. Skilled manual 4. Non manual 5 High rank
12) Smoking: 1. Smoker 2. Non-smoker 3. Ex-smoker
13) Family history of DM: 1. Yes 2. No
14) Did you have foot ulcer before? 1. Yes 2. No 1. Yes 2. No
15) How many months do you have DM?
16) Do you take medication regularly to control 1. Yes 2. No
DM?
14) Types of treatment : 0. Diet 2. OAD 3. Insulin 4. Both OAD and insulin

Part B: Knowledge (Do you agree with the below statements?)

1- Washing feet daily with soap will prevent foot infection and keeps foot healthy. 1. Yes 2. No
2- Washing with warm hot keeps feet soft and prevents cracking. 1. Yes 2. No
3- After washing feet, wearing slippers is a good habit as it protects feet from accidental injury.
1. Yes 2. No
4- Excessive moisture lotion or oils used in between toes to prevent maceration.
1. Yes 2. No
5- Moisturizing cream or oil keeps feet healthy and soft. 1. Yes 2. No
6- Daily inspection of feet is important to detect the danger early as: cut, blister, redness, callus, etc.
1. Yes 2. No
7- Regular toenail cutting is not necessary. 1. Yes 2. No
8- Toenails should be cut straight and across. 1. Yes 2. No
9- When buying new shoes, feet should be measured and soft shoes to be chosen. 1. Yes 2. No
1
10- Inspect footwear inside before putting them is not important 1. Yes 2. No
11- Stocking is important. 1. Yes 2. No

Part C: Practice
1- Do you wash your feet daily? 1. Yes 2. No
2- Do you always test temperature of water
before putting your foot in? 1. Yes 2. No
3- Do you wear slipper at home? 1. Yes 2. No
4- Do you dry your feet after wash? 1. Yes 2. No
5- Do you use moisturizer between the toes? 1. Yes 2. No
6- Do you use moisturizer on your feet? 1. Yes 2. No
7- Do you inspect your feet daily for any lesion? 1. Yes 2. No
8- Do you cut nails regularly? 1. Yes 2. No
9- Do you cut them straight and across? 1. Yes 2. No
10- Do you inspect inside shoes before wearing it? 1. Yes 2. No
11- Do you wear shoes ever without socks? 1. Yes 2. No
12- What type of shoe you wear usually? 1. Sandals 2.Athletes
3. Pointed toes 4. Round toes 5. High heels 6. Special

Part D (History): MICHIGAN NEUROPATHY SCREENING INSTRUMENT

1. Are your legs and/or feet numb? 1. Yes 2. No
2. Do you ever have any burning pain in your legs and/or feet? 1. Yes 2. No
3. Are your feet too sensitive to touch? 1. Yes 2. No
4. Do you get muscle cramps in your legs and/or feet? 1. Yes 2. No
5. Do you ever have any prickling feelings in your legs or feet? 1. Yes 2. No
6. Does it hurt when the bed covers touch your skin? 1. Yes 2. No
7. When you get into the tub or shower, are you able to tell the
hot water from the cold water? 1. Yes 2. No
8. Have you ever had an open sore on your foot? 1. Yes 2. No
9. Has your doctor ever told you that you have diabetic neuropathy? 1. Yes 2. No
10. Do you feel weak all over most of the time? 1. Yes 2. No
11. Are your symptoms worse at night? 1. Yes 2. No
12. Do your legs hurt when you walk? 1. Yes 2. No
13. Are you able to sense your feet when you walk? 1. Yes 2. No
14. Is the skin on your feet so dry that it cracks open? 1. Yes 2. No
15. Have you ever had an amputation? 1. Yes 2. No

Total:

2
Part E: (Physical Assessment) MICHIGAN NEUROPATHY SCREENING INSTRUMENT
1. Appearance of Feet

Right Left

a. Normal 0 Yes 1 No Normal 0 Yes 1 No

b. If no, check all that apply: If no, check all that apply:

Deformities Deformities

Dry skin, callus Dry skin, callus

Infection Infection

Fissure Fissure

Other Other

Specify: specify:

Right Left

Absent Present Absent Present

2. Ulceration 0 1 0 1

Present/ Present/

Present Reinforcement Absent Present Reinforcement Absent

3. Ankle Reflexes 0 0.5 1 0 0.5 1

Present Decreased Absent Present Decreased Absent

4. Vibration 0 0.5 1 0 0.5 1

perception at great toe

5. Monofilament Normal Reduced Absent Normal Reduced Absent

0 0.5 1 0 0.5 1

Signature: Total Score /10 Points

Hemoglobin A1C over the last 3 months ( )

Height: ( )
Weight: ( )