# Self-Care Planning and Sanitary Education in the Prevention of the Diabetic Foot
## 4 Discussion  
Regarding PD self-care, the authors agree that the implementation of a health education program (HEP), in addition to multidisciplinary work, favors the prevention of PD ulcers and reduces the risk of amputation [1; 4; 6; 9; 10]. It is observed that patients with a lower educational level, a lower income, and who also have worse eating habits and glycemic controls are more likely to develop PD complications [3; 12; 37]. Studies showing \begin{table}
\begin{tabular}{c c c c c c c} \hline
**Item** & **Medline/** & **Volume** & **Research** & **Elsevier/** & **Scopus** & **Total** \\
**Criteria** & **Pubmed** & & **Care** & **Embase** & **Scopus** & **Total** \\ \hline Identified & 26 & 7 & 21 & 53 & 7 & 114 \\ Duplicates & 3 & 2 & 3 & 4 & 2 & 14 \\ Title & 4 & 1 & 3 & 8 & 1 & 17 \\ \hline Abstract & 5 & 1 & 6 & 18 & 1 & 31 \\ Text & 1 & 1 & 5 & 9 & 1 & 17 \\ complete & Valid & 13 & 3 & 4 & 14 & 3 & 37 \\ \hline \end{tabular}
\end{table} 
Table 1: Databases consulted. intensive health education programs have better results in the incidence of PD ulcers [2,7]. Nurses should have greater responsibility and inspire self-efficacy in the patient [27,28]. The use of infrared thermometers has been shown to detect the thermal rise that allows action before ulcers appear [17,22,23,24,34]. A certain preventive approach is needed since the risk factors for PD are different according to sex, with the use of insulin, neuropathies, ulcers, numbness, and stiffness of MMII standing out in women, hyperkeratosis and claw fingers [31]. PD ulcer prevention measures have been identified: A health education program for the patient, type of footwear, use of socks, avoiding pressure zones, teaching the proper way to cut the nails, reporting any injury, pain, or temperature change in the feet, daily foot washing, identifying and managing PVD and infectious processes [33]. Creating an instrument to evaluate PD facilitates the diagnosis and treatment of complications [14]. Performing Buerger exercises improves neuropathy and peripheral circulation [15]. Likewise, measures have also been identified to examine the feet in consultation: palpation of the pediatric pulses, check sensitivity with monofilament or tuning fork, observe hyperkeratosis or nails, examine deformities, history of previous ulcers, check for signs of ulceration, examine any pain, and inspect footwear [16,19,25]. Home nursing interventions are described: assessment of metabolic status (glycemic control, HbA1c, weight, BMI, and nutrition), complications (blood pressure measurement, ABI, measurement of sensitivity and foot care), and health education program [27,28,35,21]. The best care at home is related to greater experience, interdisciplinary work, and health education programs [35]. The main treatment of the ulcer is to eliminate necrosis and control exudation, favoring healthy tissue. To eliminate necrosis, after washing with serum, debridement is performed, which can be cutting, enzymatic or autolytic, infection management, maintenance of perilesional skin, control of anesthesia and disease [5,19,26]. Neuropathic ulcers are observed to heal earlier, but it depends on the related factors of healing: age and values of pressure and tissue-perfusion [32]. A health education program (HEP) for PD prevention and self-care must follow the following recommendations [37,38,39,37,36,12,13,22,37,38,39]:  
1. Perform a daily foot examination, observing color and temperature, paying special attention to interdigital spaces where blisters, wounds, maceration, or excoriation can be found. With the help of a mirror, you should also inspect the sole and heel of the foot. 2. Wash your feet with water and neutral soap without exceeding 5 min. Rinse the soap with warm water and dry carefully, especially the interdigital spaces. Pat dry, neve rub. 3. Do not use excessively hot water for foot washing. The water temperature should not exceed 37 \({}^{\circ}\)C.
4. Use moisturizer after hygiene, but never between the toes due to the possibility of maceration. 5.