# Self-Care Planning and Sanitary Education in the Prevention of the Diabetic Foot
## 1 Introduction  
Currently, Diabetes Mellitus (DM) is considered one of the most serious pathologies worldwide [1; 2]. DM has a highly variable prevalence since it depends on the socioeconomic range and geographical area. Society has changed in the last century, making DM the leading cause of disease in North America and Europe, while in developing Asia and South America, this pathology is increasing. Similarly, many people are unaware that they have this disease [3; 4]. In 2015, 422 million people were diagnosed with DM [2]. According to the International Diabetes Federation, in 2040, there will be 642 million diabetics [1]. These forecasts are attributed in part to the impoverishment of lifestyles, increasingly associated with a sedentary lifestyle and lousy food, population growth, aging, urbanization, and globalization [2]. The prognosis of DM is worrying due to the numerous chronic complications associated with said disease, which may be microvascular complications such as retinopathy, nephropathy or diabetic neuropathy (DN), or macrovascular complications such as coronary artery disease, stroke, or vascular disease peripheral (PVD), in addition to the neurological complications associated with diabetic foot (PD) [3; 4]. The microvascular complication that most frequently produces the appearance of PD is DN, affecting half of the patients after two decades of evolution due to hyperglycemia. The PD is the demyelination of the neuronal axons as a consequence of hyperglycemia maintained over time, which causes the functional and structural deterioration of the peripheral nerves, causing a lack of peripheral sensitivity, deformities, and ulcerations. The infection or ulceration process is not only associated with neurological failures but also with different degrees of PVD that in diabetic lower limbs (MMII) is known as PD [1]. Globally, diabetic patients have an incidence of ulcerated PD of around 20%, having a 40% chance of recurrence of healed ulcers in the first year [2], being more susceptible to loss of MMII [3]. It is considered an incapacitating, irreversible, and costly complication of DM, with a series of social, mental, and physical consequences [4]. It is important to know that DM has no cure today, but there is a treatment to avoid the consequent problems through the control of risk factors such as the management of the glycemic level, blood pressure, and cholesterol levels, in addition to others such as weight, diet, or level of physical activity [3]. Also, one of the most important risk factors, according to the American Diabetes Association, is poor therapeutic education. This emphasizes the educational orientation for the prevention of these complications, strengthening the importance of the prevention of ulcerations in the MMII through their daily care [1]. A large number of diabetic patients do not have the necessary knowledge to care for MMII; however, an essential element in PD intervention is patient collaboration [2]. In DN, sensory symptoms on motors stand out [5]. The effect of sensory neuropathy is loss of sensitivity, leaving the foot fragile in the face of bruises that cause a break in the skin, resulting in the appearance of ulcers on the foot [2]. Motor neuropathy leads to structural deformity of the foot. These deformities increase the mechanical pressure on the metatarsal heads and phalanges, inducing the appearance of ulcers in the PD [2]. The circulatory and sweat systems are compromised by autonomic neuropathy and impaired nerves, reducing perspiration, leaving the skin dry, and favoring the appearance of hyperkeratosis due to mechanical pressure, which makes it more susceptible to the appearance of injuries [5]. At the same time, poor vascular perfusion produced by PVD and immunity prevents wound healing, making the risk of infection higher [5]. All these etiological factors (neuropathy, PVD, infection, etc.)