[in Japanese]

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[in Japanese]

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 Out-of-hospital foot care is mainly provided at home, where importance is placed on “care perspectives”. However, the nationwide dissemination of foot care with care perspectives seems to be a challenge due to the difficulty of performing such care in care services. On the other hand, in care services, it is feasible to take care of the feet as part of “physical care”, and care workers, who directly support patients’ and users’ daily lives, may be able to provide good care. This study describes foot care in care services.

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 Patients with critical limb ischemia（CLI）who undergo transmetatarsal amputation for gangrene of Rutherford VI to preserve the heels sometimes require a subsequent major amputation due to poor wound healing. These patients require additional long-term treatments, resulting in poor muscular recovery and lower activities of daily living（ADL）after discharge. On the other hand, a subset of patients who undergo below-the-knee amputation as the initial procedure are able to recover quickly with a prosthetic leg that helps with ADL. Thus, it is challenging to select the most appropriate treatment strategy. In order to identify indicators that may help select an appropriate treatment strategy, we reviewed cases of patients who did and did not require major amputation at our institution. A total of 31 patients with CLI（37 critically ischemic legs）were included in the study. Our findings demonstrated that patients who: 1）were unable to walk, 2）had hypoplastic left heart syndrome, and 3）had high white blood cell counts and C-reactive protein levels were significantly more likely to require major amputation.

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 The maintenance of foot function to be able to walk until the end of life is indispensable for the maintenance of activities of daily living and quality of life, and, therefore, it is key to extending a healthy lifespan in Japan. As the number of community-dwelling elderly people is increasing, there is an increasing need for foot care. In such a situation, nursing/care professionals, who support the elderly, are expected to have sufficient knowledge and practical skills related to foot care. This paper classifies points to be noted about risk management measures in foot care for the community-dwelling elderly.

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