Indigenous Diabetes Health Circle “formerly SOADI”

Circle of Care Program’sWholistic Foot Care

Indigenous peoples have the

tools, knowledge and ability

to make healthy choices and

live free of diabetes,

now and in future generations.

IDHC’s Vision

IDHC will achieve the vision by supporting Indigenous communities, families and individuals by:

• Promoting holistic wellness models;

• Building on traditional teachings and best practices to develop and provide programs, education and resources; and

• Building relationships and community capacity.

IDHC’s Mission

Office Locations:

Head Office: Thorold

Northern Region: Sudbury, Eastern Region: Curve Lake First Nation, Southern

Region, Hamilton, Western Region: Six Nations, Central location: Barrie

IDHC Services in Ontario

Our Model:

Our holistic model supports a continuum of seamless foot care services based on education, screening, care, treatment, support and data collection.

It strengthens local community collaboration.

The Circle of Care Program and Holistic Foot Care Model

Since February 2006

Our Focus:

To provide foot care services to Indigenous people that are affected by or at risk of diabetes and its complications.

We strive to assist individuals through education, self-care resources, professional assessment and referrals.

Healthy Feet are Happy Feet

The Circle of Care Program and Holistic Foot Care Model

Since February 2006

Four Components of IDHC’s Circle of Care Program

1. Holistic Foot Care EventsOutreach and Assessment Focus

2. Sustainable Foot Care Locations Self Care Programing and Ongoing treatment

3. Individual Foot Care SubsidiesAccess to include Home Visits; Ongoing Care and Support to those who do not qualify for other funding sources

4. Self Care and Prevention Resources Self Care DVD, Mirror, Diabetic Socks, and other foot care tools

All services are accessed through the website www.idhc.life

Foot Care Events

Circle of Care Community EventsProcess for community members to be

assessed, educated, and referred for follow up

Registration and screening

# 1-25 seen in am

# 25-50 seen in pm

Education while Waiting

Educationopportunity

Reflexology

EvaluationSelf Care

Resource Kit

Chiropody/Foot Care Nurse

Chiropody

Chiropodists like Podiatrists specialize in foot care.

- They specialize in diagnosis, medical and surgical treatment of disorders of the foot, ankle, and lower extremity.

- Primary care includes:

common foot conditions, foot infections, foot deformities, orthotic requirement and diagnosis of foot disease and disorders.

- Diabetic Foot Assessments:

check the general health of the feet which includes circulation and sensation.

- IDHC Foot Care Clinic includes:

full foot assessment, nail care, ingrown toe nails, corns, callus, plantar warts, skin care, and orthotic assessment.

Tools used are:

Monofilament Nail File

Doppler

Ingrown nail file

Nail cutters

Callus Shaver

Foot Care Nurses

Foot Care Nurses are registered nurses that have certification in Advanced Foot Care and are registered with the College of Nurses.

- Primary care consists of:

general health of the feet, assessments of circulation and sensation, non- invasive nail and skin care, and recognizing abnormalities.

- Total foot care provided:

nails, ingrown toe nails, corns, callus, and skin problems. Please note infections and planter warts are referred to a Chiropodist or Family Doctor.

Referrals to appropriate health service provider.

Reflexology

Reflexologists

What is Reflexology?

Reflexology is a focused pressure technique, directed at the feet.

It is based on the premise that there are zones and reflexes on different parts of the body. which corresponds to and relate to our body parts, glands and organs.

There are approximately 7200 nerve endings on the feet, and these relate to various organs and glands within the body.

A mirror image of the body has been mapped on the feet and pressure applied on specific reflex points on the feet can affect the corresponding part of the body.

Our ancestors used reflexology as a part of their healing, and we continue in their footsteps.

Reflexologists: certified through regulated colleges such as Reflexology Association of Canada (RAC)

Benefits of Reflexology

Reflexology treatments provide deep relaxation, which reduces stress and tension that can aggravate diabetes.

Enhances circulation: Blood and lymph circulation improves, blood supply to the cells is improved, and the release of toxins from the body is increased.

Stimulates pancreas and liver / helps in maintaining blood sugar level / Reduces blood sugar fluctuations.

Stimulates the nerves and encourages biofeedback

Following a reflexology treatment it is important for the next few days to drink plenty of water and rest when ever possible.

Foot Care’s Self Care Resources

• IDHC Circle of Care Program’s Self Care Resources are part of a tool bag that we provide that motivates and assist when practicing daily self care management.

• Self care resources are important to use when practicing healthy foot care and preventative self care.

Foot Care’s Self Care Resources

• These tools include:

- Full size mirror,

- Diabetic Socks,

- Diabetic Pamphlet Series,

- Foot care pamphlets,

- First aid kit,

- Soap & Foot Cream,

- Foot File & Footsie brush,

- Stone,

- Magnet,

- Pen,

- Vinyl tool bag

• In 50 years, diabetes has become a significant health concern for Aboriginal people in Canada.

• The prevalence rates are 3-5 times higher among Aboriginal people than in the general Canadian population.

Communications Benchmark Study: Awareness and Knowledge Levels of Type 2 Diabetes Among Aboriginal Peoples in Canada, Ipsos-Reid - January 2002. Aboriginal Diabetes Initiative (ADI), Health Canada. .

Prevalence of Diabetes in Indigenous Communities

Diabetic Foot Care Statistics

• Up to 5% of all diabetics currently have a foot problem.

• Foot complication is the number one cause of hospital admissions for diabetics.

• Almost half (43%) of all diabetics have their first hospital admission associated with a foot ulceration/infection.

• Most amputations begin with ulceration. (85% +)

• One in 6 diabetics will develop an ulceration in their life time.

• Mortality rate is higher post amputation or ulceration.

WHY???

Risk Factors:Sensation loss…undetected injury. Not Able to feel pain.

Circulation loss…

A 70 year old person with diabetes has a 70 times increased chance for gangrene versus a non-diabetic of the same age

…200 times increased chance if also a smoker.

Jonathon Clarke -RVH DMC Foot Clinic

Diabetic Foot Care Statistics

Diabetes Foot Care Risks and ComplicationsWhy should people living with Diabetes take

EXTRA care of their feet?

Uncontrolled

DiabetesDecreased feeling &

sensation in feet

Increase risk of injury

Longer for body to heal

properly

Increase risk of infection

Possible amputation

Nerve damage and decreased blood

circulation

Continuous open wound

Neuropathy

Develop Prolong Infections

Combination of loss of blood circulation and/or uncontrolled

infection

Diabetes and Foot Care PreventionWhat you can do to prevent foot

complications.

• Eating regular balanced meals from each of the four food groups.

• Drinking plenty of water.• Medications/insulin as prescribed.• Control stress levels.• Reduce: sugar, salt, white flour, high fat

dairy and lard. • Family Doctor for HbA1C every 3 months.• Check blood sugar regularly

Professional Foot Care

Control Blood Sugar

Love your feet daily

Regular Daily Exercise

Diabetes and Foot Care PreventionWhat you can do to prevent foot

complications.

• Eating regular balanced meals from each of the four food groups.

• Drinking plenty of water.• Medications/insulin as prescribed.• Control stress levels.• Reduce: sugar, salt, white flour, high fat dairy and

lard. • Family Doctor for HbA1C every 3 months.• Check blood sugar regularly

• Look at your feet closely every day, use a mirror and IDHC foot care resources.

• Wash (Luke warm water mild soap), dry (between toes), moisturize feet but NOT between toes daily.

• Look for changes daily (blisters, bruisers, red areas, open sores etc).

Professional Foot Care

Control Blood Sugar

Love your feet daily

Regular Daily Exercise

Diabetes and Foot Care PreventionWhat you can do to prevent foot

complications.• Eating regular balanced meals from each of the

four food groups.• Drinking plenty of water.• Medications/insulin as prescribed.• Control stress levels.• Reduce: sugar, salt, white flour, high fat dairy and

lard. • Family Doctor for HbA1C every 3 months.• Check blood sugar regularly

• Exercise stimulates circulation and blood flow.flow and strengthens the heart.

• Helps reduce stress build up in your body.• Be physically active and do things you enjoy.

• Look at your feet closely every day, use a mirror and IDHC foot care resources.

• Wash (Luke warm water mild soap), dry (between toes), moisturize feet but NOT between toes daily.

• Look for changes daily (blisters, bruisers, red areas, open sores etc).

Professional Foot Care

Control Blood Sugar

Love your feet daily

Regular Daily Exercise

Diabetes and Foot Care PreventionWhat you can do to prevent foot

complications.

• See a professional every 6 weeks. • Do not cut your own toe nails.• Do not remove your own corn or calluses• Proper foot wear.• Address ANY foot concerns

immediately.• IDHC subsidy available

• Eating regular balanced meals from each of the four food groups.

• Drinking plenty of water.• Medications/insulin as prescribed.• Control stress levels.• Reduce: sugar, salt, white flour, high fat dairy

and lard. • Family Doctor for HbA1C every 3 months.• Check blood sugar regularly

• Exercise stimulates circulation and blood flow.

• Strengthens the heart.• Helps reduce stress build up in your body.• Be physically active and do things you enjoy.

• Look at your feet closely every day, use a mirror and IDHC foot care resources.

• Wash (Luke warm water mild soap), dry (between toes), moisturize feet but NOT between toes daily.

• Look for changes daily (blisters, bruisers, red areas, open sores etc).

Professional Foot Care

Control Blood Sugar

Love your feet daily

Regular Daily Exercise

Common Foot Concerns

http://mcdermottfootcare.

com/2012/03/

http://www.radiologyassistant.nl

• Foot Deformity-bone changes, structure changes,

• Abnormal foot shape and prominent bony abnormalities are dangerous to the diabetic foot because they create pressure points which can lead to skin breakdown

• Hammer / Claw / Mallet toes

• Overlapping / Missing digits

• Bunions / Tailor’s Bunionette,

• Hallux Limitus/Rigidus, Charcot

Foot

Common Foot ConcernsFoot and Skin Lesions

Dryness-lack of blood flow and moisture level in skin

Calluses- hardened skin that has not been scraped off which can lead to ulcers

Fissures-cracks commonly in the heels from pressure on the dry skin

Interdigital maceration-can be a sign of athletes foot or fungus

Dryness and calluses leading to cracks

http://www.dermnetnz.org/http://www.angelopodiatry.com/heel-fissures.htmlhttp://fixingyourfeet.com/

Athletes foot, fungus

Ulcers- open wound that is slow to heal

Corns- circular harden funnel often caused by pressure

Warts- referred to as plantars warts which is a virus infection on the bottom of your feet.

Blisters- sack of fluid over areas that has experienced trauma or friction

Colour change, temperature change, and edema- can be a sign of poor blood circulation PAD or infection

Common Foot ConcernsFoot and Skin Lesions

Blister

Wart

Assessment of the skin can help you determine if the person has autonomic neuropathy and or PAD

Corn

Common Foot Concerns Nail Pathology

Ingrown / involuted toenails-can be referred to as curly nails, nails cut too short and cut down the side. People can be predisposed to ingrowns by the nail structure

Dystrophic-nail damage or trauma to nails causing deformity

Onychomycotic-fungal infection of the nail, often with a yellow and thickened appearance and nail lifting from nail bed.

http://www.nbfootcare.com/Foot-Education.htmlhttp://www.thepodiatry-clinic.co.uk/nail-surgery.htmlhttp://emedicine.medscape.com/article/1105828-overview

Onychogryphotic-nails resembling claws or a ram's horn, caused by injury, most often secondary to self-neglect and failure to provide self management.

Thickened nails may indicate arterial disease!

Peripheral arterial disease (PAD) is a disease in which plaque build up in the arteries that carry blood through out your body.

This plaque build up over time can harden and narrow the arteries, which limits the flow of oxygen-rich blood to part of the body specifically the extremities (finger tips, eyes, feet)

http://www.nbfootcare.com/Foot-Education.htmlhttp://www.thepodiatry-clinic.co.uk/nail-surgery.htmlhttp://emedicine.medscape.com/article/1105828-overview

Common Foot Concerns Nail Pathology

Self Inspection

Foot Care Self-Inspection-

It is strongly encouraged that anyone living with diabetes does a self inspection daily

What items are needed:

• Large mirror, • First aid kit, • Checklist or a guideline handout to follow, • Marker or pen, • Wash clothe and towel.

Example of a Checklist

Self Inspection

Steps to take:

• Take shoes and socks off and clean feet with wash clothe

• Using the mirror look over the whole foot to notice any changes or signs of concern

• If a concern is found it will need first aid attention.

• If a checklist is present, any changes should be marked and appointment be booked.

Proper Foot Wear

Proper foot wear is an important component in preventative care. Many foot concerns arise due to improper fitting shoes.

If the shoe fits:

Indigenous community have wider feet than the general population

Proper Foot Wear

Purchase and checks:

• Shop later afternoon.

• Get fitted with measurement tool ie: Brannicks foot sizing tool

• Try both shoes on in the store and walk around before purchase

• Break shoes in slowly by wearing them inside and for 2-3 hours a day for a week.

• Never go with a larger size to get a bigger width.

• Inspect older shoes for signs of wear and replace when necessary

• Look: at the tread, material, support, stability, insoles and inside seams

Photo by Jeremy Bouchard

“Traditional healing is an integrated, holistic approach to health. The body, mind, spirit and emotions of the individual are all viewed as equally important.” Jan Kaheti:io Longboat,

Traditional Wellness

National Aboriginal Health Organization (NAHO), Summer 2002 edition, page 5.

“We have all the tools that we need to have that good life, and to stay in balance and harmony. It’s up to us as people to look after ourselves in a good way. It’s our responsibility, to take back that good life and make it our own.” Jan Kaheti:io Longboat,

In the Spirit of Healing and Wellness, Vol 6, Number 1, Winter/Spring 2005. P 12.

Jan Kahehti:io Longboat is a Mohawk herbalist, healer and Elder. Her expertise is recognized by Indigenous communities across Turtle Island.

She has taught Indigenous healing practices and Indigenous healing and wellness in communities, universities and colleges, among them Mohawk College, McMaster University and the University of Toronto.

Jan Kaheti:io Longboat

This helps to reveal the knowledge and healing

that exists within the medicine wheel using the 7

Grandfather Teachings

These teachings reflect how oneself is

responsible for looking within oneself

Diabetes Medicine Wheel with Healing and Wellness

Holistic approach to learning and coping to live with

diabetes.

Framework for Practicing

Holistic Health

Taking care of one another while taking care of ourselves:

• Why our personal health helps our community health

•Why our feet are important in our health journey

• Why we should not take our health or feet for granted.

How we can take care of our selves and our feet.

• Keep sugars in control: Between 4.0 to 6.0 mmol/L (72 to 108 mg/dL) when fasting. Under 7.8 mmol/L (140 mg/dL) 2 hours after eating.

• Always wear socks and shoes/moccosins.

• Washing our feet, trimming our toe nails, self inspection daily

Educating Our Community

Educating Our Community

Taking care of one another while taking care of ourselves:

Bring Knowledge Home to Family.• Remind mommy’s and daddy’s to check feet.• Help Aunties, Uncles, Grandma’s and Grandpa’s to check their feet.

Keep eyes open.• Watch for proper or ill fitting shoes, can cause long term damage.• Watch for shoes and no socks, can cause long & short term damage.• Watch for signs of concern: cuts, sores, discharge, swelling, blood, odor, pain• Bring to care givers attention.

“Your feet walk upon the earthand through this,

Your spirit is connected to the Universe.” (Jenny Wallace; Cherokee, North Carolina, History of

Reflexology.)

Chi Miigwetch, Nya:weh & Thank you!

For more information please visit our website:

www.idhc.life

1-888-514-1370