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