Foot care

1. Foot care Diabetes Outreach(June 2011)

2. Foot care • Learning objectives • To understand peripheral vascular disease (PVD) • To understand neuropathy (nerve disease) • To be able to undertake a basic foot assessment • To be aware of the important factors for prevention of foot problems.

3. Peripheral vascular disease (PVD) • The risk of PVD increases with the duration of diabetes. • Other risk factors include hyperglycaemia, smoking, hypertension and hyperlipidaemia. • PVD is associated with a 2-4 fold increased risk of amputation. • All people with diabetes should be regularly screened for PVD.

4. Signs and symptoms PVD • foot pulses (diminished/absent) • claudication (pain in the back of the leg) • intermittent • at rest and/or nocturnal • shiny appearance of skin • bluish discolouration of skin • loss of hair on feet and toes • failure of a wound to heal/gangrene • leg colour slow to return after elevation • significant temperature difference between leg and foot.

5. Peripheral neuropathy Peripheral neuropathy is a major underlying risk factor for the development of ulcers. Neuropathy is more common as the duration of diabetes increases. There is abnormal/reduced feeling which can lead to; • painless callus/corn formation • painless injuries • changes in shape of foot.

6. Neuropathy: signs and symptoms • abnormal, decreased or increased sensitivity • loss of deep tendon reflexes • loss of vibratory, cutaneous pressure, temperature or position sense • heavy callus formation over pressure points • trophic ulcers • foot drop • changes in shape of foot.

7. Foot risk assessment and management Five key elements • regular inspection and examination of the feet by health care providers • identification of the foot at risk • education of the person, family and health care providers • appropriate foot wear • treatment of non-ulcerative pathology.

8. Assessment • diabetes control • blood vessel changes • sensation changes • mechanical factors • condition of skin and nails • previous problems.

9. Daily care • wash and dry feet daily • inspect for signs of injury or pressure • moisturise dry skin • treat minor skin damage • trim toe nails.

10. close observation protect and cushion bony protuberances, ankle bones, heels, ‘bunions’ use lambskin boots, protectors, foam, air pillows and inform theatre nurse 2/24 hour pressure care if immobile keep feet warm with socks or boots wash and dry thoroughly, attend to foot care slippers on if ambulant. Foot care in hospitals

11. Prevention • patient education/staff education • daily inspection/assessment • smoking • avoid commercial corn & callus treatments • avoid electric blankets, hot water bottles or microwave bean bags if at risk feet.

12. Prevention • encourage good supportive shoes • avoid walking bare-foot (if at risk foot) • wool or cotton socks • do not use garters or tight socks • pressure area care when in hospital.

13. Foot ulcers • improve circulation • early antibiotics • debridement • specialist wound management.

14. Case discussion • Johnny is 45 years old and has had type 2 diabetes for 15 years. Your assessment identifies that he has neuropathy. • Using the proforma for a foot care protection plan on the next slide map out the key points for Johnny. • Is there any other information about Johnny that you require?

15. My Foot Care Protection Plan

16. References • Diabetes Outreach (2009) Diabetes Manual, Section 6: Footcare.