Closing the stable door after the horse has bolted: exploring Charcot foot health literacy among individuals with diabetic peripheral neuropathy in Scotland

Abstract

Charcot foot is a potentially devastating complication of diabetic peripheral neuropathy (DPN). The frequently asymptomatic nature of this condition may lead to delayed recognition, diagnosis and pressure relief, associated with a characteristic ‘rocker bottom’ foot deformity. Deformity may, in turn, precipitate diabetic foot ulceration (DFU), infection and, ultimately, lower extremity amputation (LEA). Podiatric diabetes self-management education and support (DSMES) strategies have historically focused on DFU and LEA prevention, reserving Charcot foot information for those with ‘Active’ disease.

The World Health Organisation defined health literacy (HL) as those personal traits and social support mechanisms required to understand and apply health information and access appropriate services. Specific traits and social support required to recognise and respond to early Charcot ‘danger signs’ were defined as ‘Charcot foot health literacy’ (CFHL). A resultant ‘Charcot foot health literacy conundrum’ was proposed, as individuals with DPN, ‘At-risk’ of Charcot foot, were not informed of their risk status nor did they receive targeted education or support.

The research hypothesis was that individuals with Charcot foot experience, classified as ‘In Remission,’ developed specific CFHL traits through exposure to podiatric DSMES and reflection on past experience. This pragmatic, mixed methods research compared general, multidimensional HL and ‘Knowledge,’ ‘Understanding’ and ‘Contextualisation’ CFHL skills between people with and without Charcot foot experience, with the Health Literacy Questionnaire and a novel CCHAIR Study Qualitative Questionnaire, respectively.

Study findings confirmed ‘At-risk’ individuals lacked Charcot foot knowledge. All participants more readily associated this condition with late-stage complications, rather than early inflammatory signs. Charcot foot experience was associated with active self-management and those ‘In Remission’ remained engaged with specialist podiatry and/or multidisciplinary services. Future DSMES approaches should target all individuals with DPN, focusing on prompt self-recognition of, and self-referral in the event of, Charcot foot ‘danger signs.’