Foot care Diabetes Outreach (June 2011). 2 Foot care Learning objectives >To understand peripheral vascular disease (PVD) >To understand neuropathy (nerve.

Foot care

Diabetes Outreach(June 2011)

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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.

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> 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.

Peripheral vascular disease (PVD)

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> 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.

Signs and symptoms PVD

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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.

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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.

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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.

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Assessment

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

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Daily care

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

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Foot care in hospitals

> 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.

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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.

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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.

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Foot ulcers

> improve circulation> early antibiotics> debridement> specialist wound

management.

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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?

My Foot Care Protection Plan

Assessment Potential problems Action

Feeling    

Blood supply    

Skin and nails    

Foot structure

Footwear    

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References

> Diabetes Outreach (2009) Diabetes Manual, Section 6: Footcare.

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