Appraising the Multi-SAFE approach to low vision and diabetes: a simple technique for saving feet

The human and economic consequences of diabetes-related foot problems can be harrowing. A person’s foot can become vulnerable due to various complications of diabetes. Nerve damage, vascular problems and delayed wound healing can lead to chronic ulceration. Ensuing infection or the non-healing of an ulcer can result in amputation – one of the most feared and most costly outcomes of diabetes. People with diabetes who also have a visual impairment are at even greater increased risk for serious foot problems and amputation. For those with good vision, efforts to prevent amputation often include education in foot self-examination; people with impaired vision are usually advised to seek assistance from a sighted person for daily foot inspection. Clinical experience suggests that visually impaired people seldom follow this advice. In this article, Ann Williams explains why and reports on a project in the USA in which people with diabetes and impaired vision learn techniques to examine their own feet using a range of senses and, it is hoped, reduce the threat from severe complications, including amputation.