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Best Foot Forward - Diabetes Speciality Services
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Transcript of Best Foot Forward - Diabetes Speciality Services
Best Foot ForwardDiabetes SpecialityServicesDr Sanjay K ShahNarayana Multispecality Hospital Howrah
Complications of diabetes
• Diabetes can cause increased risk of:– Heart Problems– Stroke– Eye sight problems– Kidney problems– Foot problems
Multidisciplinary teamwork withholistic approach
podiatry
Therapeutic footwear
Consultant in
orthopaedicsdiabetes
nurse
orthotics
Consultant in
vascular surgery
Consultant in
diabetes
patient
GP and community services
Hospital services
Why do Foot problems occur
• The feet can be affected by:
– Decreased blood supply poor healing
– Nerve damage loss of feeling
– High Blood Sugar levels infection & healing
Structural Abnormalities
Peripheral Arterial Assessment
Skin changesEvidence of infectionCallous or ulcerRange of motionCharcot foot
TemperatureSkin changesAnkle Brachial Index
Neuropathy Assessment 10 gram monofilament
Neurosthesiometer
How to Perform Proper Foot Examination
Assessment and awareness
• Always be aware of High Risk Feet– Loss of feeling– Poor blood supply – Past history of foot ulcer
Rapid Screening for Diabetic Neuropathy Using 10 gram Semmes-Weinstein Monofilament
Loss of sensation over the distal plantar surface to the 10g monofilament is a significant and independent predictor of foot ulceration and lower-extremity
amputation.
Neurological Exam
• Biothesiometer– Best predictor of foot
ulcer risk• 128-Hz tuning fork at
halluces– Equivalent to 10-g
monofilament– Newly recommended
by ADA
Diabetes Care. 2006;29(Suppl 1):S25Diabetes Res Clin Pract. 2005;70:8
Pulses and ABPI
Adapted from: Norman PE, Eikelboom JW, Hankey GJ. Peripheral arterial disease: prognostic significance and prevention of atherothrombotic complications. Medical Journal of Australia 2004; 181:150-154. Figure 1, p.151
FOOTWEAR EXAMINATION
SENSORY NEUROPATHY
Bad Footwear
FOOT WEAR
Preventing foot problems
• Appropriate shoes– Pointed toes or high heels
put too much pressure on the toes.
– Shoes also need to be deep and wide enough to prevent rubbing.
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
PODIATRY
Local factors
Systemic factors
Wound carePressure offloadingDebridement (nonischemic wounds)
Glycemic controlTreat infectionAddress lower-extremity vascular status
Foot Ulcer: Multidisciplinary Team Approach
Therapeutic Footwear Efficacy
• Protect feet• Reduce plantar pressure, shock, and shear • Accommodate, stabilize, support deformities• Suitable for occupation, home, leisure• Padded socks (e.g., CoolMax, Duraspun, others)• Shoe inserts/insoles (closed-cell foam, viscoelastic)• Therapeutic shoes• Decreases plantar pressure 50%-70%• Uncertain reduction in ulcer rate
Diabetes Care. 2004;27:1774
DO ….Check your feet every day for cuts, cracks, bruises, blisters, sores, infections, unusual markingsUse a mirror to see the bottom of your feet if you can not lift them upCheck the colour of your legs & feet – seek help if there is swelling, warmth or rednessWash and dry your feet every day, especially between the toesApply a good skin lotion every day on your heels and soles. Wipe off excessChange your socks every dayTrim your nails straight acrossClean a cut or scratch with mild soap and water and cover with dry dressingWear good supportive shoes or professionally fitted shoes with low heels (under 5cm)Buy shoes in the late afternoon since your feet swell by thenAvoid extreme cold and heat (including the sun)See a foot care specialist if you need advice or treatment
EDUCATE PATIENTS ON PROPER FOOT CARE – THE “DO’S”
DO NOT …
Cut your own corns or callouses
Treat your own in-growing toenails or slivers with a razor or scissors. See your doctor or foot care specialist
Use over-the-counter medications to treat corns and warts
Apply heat with a hot water bottle or electric blanket – may cause burns unknowingly
Soak your feet
Take very hot baths
Use lotion between your toes
Walk barefoot inside or outside
Wear tight socks, garter or elastics or knee highs
Wear over-the-counter insoles – may cause blisters if not right for your feet
Sit for long periods of time
Smoke
Educate Patients on Proper Foot Care – The “DON’Ts”
Prevention is better than cure!
• Prevention and early identification & treatment of foot problems can prevent foot ulcers and amputation
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Source: Footcare in Diabetes Workbook for Health rofessionals. Australian Diabetes
Educators Association
Rest Assured