Keeping feet healthy with diabetes

Keeping feet healthy with diabetes

Method: Foot health education App co-creation & evaluation using mixed methods
Rajna Ogrin and Tracy Aylen – Bolton Clarke
Dinesh Kumar and Rekha Viswanathan – RMIT
Janine Scott and Fiona Wallace – Carrington Health
Funder/Funding: This project is funded by Eldon & Anne Foote Trust and Pam & Alfred Lavey Trust
Duration: 12 months (2016-2017)
Status: Pre-implementation phase


Diabetes is the most common cause of non-traumatic amputations in the world, with a foot ulcer being the precursor to most foot or lower-limb amputations. Annually in Australia, there are 10,000 hospital admissions for diabetes-related foot ulcers, with lower-limb amputation a common outcome. Unfortunately, despite the increasing knowledge, research and guidelines relating to this issue, data suggest there has been a 30% increase in diabetes related amputations in Australia over the past decade, with 8% of diabetes-related deaths being attributable to foot disease; and mortality rates five years after amputation in people with diabetes up to 55%.

Guidelines propose education as a way to prevent amputation in people with diabetes (PWD) (3, 4), however current education resources are limited, with no standard, validated interactive education on foot health available in Australia to support PWD to prevent escalation of their foot status to requiring amputation. Further, guidance for clinicians to provide evidence based foot assessments and management for PWD is limited.


This project will involve the co-creation and pilot of an education and decision aid App to improve knowledge, foot self-care practices and foot health outcomes of PWD, and service delivery of their clinicians.


  1. Co-create a diabetes foot health interactive education applet (App) for a smartphone, working with people with diabetes, clinicians and biomedical engineers. The use of the App aims to improve knowledge, foot self-care practices and foot health of people with diabetes.
  2. Test the App usability, functionality, content accuracy, and usefulness with people with diabetes (PWD) from each of the amputation risk level groups, and clinicians.
  3. Pilot and evaluate the effectiveness of the App to change behaviour:
    a. With 40 people with diabetes over 12 weeks; to ascertain whether it:
    (i) is used as anticipated;
    (ii) improves knowledge;
    (iii) produces improvement in foot self-care practices; and
    (iv) improves foot health outcomes;

    b. With 10 clinicians over 2 weeks; to ascertain whether it:
    (i) is used as anticipated;
    (ii) improves knowledge; and
    (iii) improves assessment and management practices for foot health in people with diabetes.

The App will be disseminated (post the granting period) through diabetes peak bodies and health provider networks.


Diabetes foot education will be co-created by PWD at different levels of risk of amputation; health professionals with expertise in care of PWD-related foot complications; generalist health providers and biomedical engineers with expertise in App development using algorithms to guide decision making.

Trialling of functionality, content accuracy and usefulness will be undertaken with PWD and clinicians to ensure the App is functional and fit for purpose.

A 12-week pilot will evaluate the App’s uptake, and effectiveness to: improve knowledge; improve foot self-care practices; improve foot health outcomes for people with diabetes.

A 2-week pilot of clinicians’ use of the App will determine whether their assessment and management practices of foot health in people with diabetes, is as recommended by the App.
Interviews and focus groups with PWD and clinicians will be undertaken to find out their experiences of using the App.

Milestones and timelines:

foot health diabetes timeline


We’d like to hear from you

Bolton Clarke is here to help you with your retirement, aged and independent living needs. For more information on our services call us or send us an enquiry online.