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  1. Takehara, Kimie PhD, RN
  2. Amemiya, Ayumi PhD, RN
  3. Mugita, Yuko PhD, RN
  4. Tsunemi, Yuichiro PhD, MD
  5. Seko, Yoko RN
  6. Ohashi, Yumiko RN
  7. Ueki, Kohjiro PhD, MD
  8. Kadowaki, Takashi PhD, MD
  9. Oe, Makoto PhD, RN
  10. Nagase, Takashi PhD, MD
  11. Ikeda, Mari PhD, RN
  12. Sanada, Hiromi PhD, WOCN, RN


OBJECTIVES: To examine the correlations between elements of feet-washing behavior, presence of tinea pedis (TP), and patients' background characteristics in order to identify a concrete intervention method to prevent TP.


DESIGN AND PARTICIPANTS: A cross-sectional study of 30 patients with diabetes (16 with TP) who were admitted to or visited the university hospital.


MAIN OUTCOME MEASURES: The presence of TP was confirmed by the detection of dermatophytes by direct microscopy. Data on elements of feet-washing behavior, such as scrubbing between the toes, were collected by observing recorded videos of participants normally washing their feet as they do at home. The patients' background characteristics included demographic data; diabetes-related factors; patient knowledge regarding diabetes, foot problems, and TP prevention; purpose for feet washing; and any difficulties in feet washing.


MAIN RESULTS: The number of times patients scrubbed between their toes while washing with soap was significantly lower in patients with TP (odds ratio, 0.95; P = .036; with a cutoff value of 35 times) and those who had difficulty in reaching their feet with their hands (B = -14.42, P = .041).


CONCLUSIONS: An effective foot-washing protocol should include specific instructions for patients to scrub between their toes at least 35 times in all 8 spaces while washing with soap. Appropriate advice is also needed for individuals who have difficulty reaching their feet with their hands. Education about appropriate foot-washing behavior may potentially prevent TP.