Psychological aspects of diabetic neuropathic foot complications: an overview

Despite recent advances in understanding and major efforts to control the biomedical risk factors for neuropathic foot complications, the rates of foot ulceration and amputation remain unacceptably high. As the current focus on physical factors alone has not led to a substantial decline in foot complications in persons with diabetes, we propose a more balanced approach with the consideration of potentially important psychological factors. Until recently, psychosocial research in diabetes has almost exclusively focused on self-care behaviours and the burdens associated with the management of glycaemia, almost to the total neglect of the effects of chronic complications including neuropathy. As the burdens associated with the complications of diabetes begin to overshadow those specific to the control of glycaemia, it is important to develop social and psychological concepts and measures that capture how patients perceive and respond to specific threats such as that of neuropathy. There is now some progress in this area as evidenced by emerging patient-centred, theory-based methods to identify psychological factors influencing adherence behaviours, emotional status and quality of life in diabetic patients at high risk of developing foot ulcers. The development of a conceptual model of patient's common-sense representations or beliefs about foot complications and the type and source of their emotional distress should allow clinicians and behavioural investigators to share ideas for the assessment of patient beliefs and behaviour, and the development of educational methods that should improve clinicians' ability to empower patients to manage their neuropathy more efficiently.