How to keep them healthy. The Diabetic Foot How to keep them healthy.

“Knowing is not enough, we must apply “Knowing is not enough, we must apply. Being willing is not enough: we must do” Leonardo da Vinci Are YOU aware of how diabetes can affect YOUR feet? That the secondary complications of diabetes can lead to lower limb amputation. AND most importantly how YOU can prevent foot problems from becoming a serious threat to YOUR health.

Good Practice: HEALTHY EATING WEIGHT CONTROL CONTROL BLOOD SUGARS STOP SMOKING EXERCISE CONTROL BLOOD PRESSURE.

A healthy lifestyle Will provide good nutrition to your cells and organs Help control risk factors associated with disease processes Can enhance mental well being Can reduce the stress and upset associated with illness

Increased risk associated with diabetes… AMPUTATION HEART DISEASE. STROKE DAMAGED VISION KIDNEY FAILURE

Sugar in the bloodstream can damage blood vessels, blocking nutrients from reaching your cells, leading to and causing Hardening of blood vessel walls Formation of ‘Sticky blood’ Plaque or clot formation in blood vessels Tissue death, necrosis and gangrene

How diabetes can affect your feet… Loss of protective Mechanism by exposed nerve fibres. Altered sensation. Limited joint mobility. Skin changes. Reduced blood supply Foot deformity

Diabetic foot disease can cause Loss of protective pain sensation ,leading to undiscovered injury and risk of infection. Altered sensation causing permanent pain and discomfort Limited joint mobility altering foot shape and mobility Skin changes leading to dry cracked skin, open wounds and ulceration Reduced blood supply leading to tissue death and gangrene Foot deformity putting the foot at risk of ulceration and amputation

Increased risks to the diabetic foot Damage to blood vessels and nerves can increase the risk of : Ulceration Infection Deformity Amputation

How diabetes can affect your feet… Slow healing wounds. Increased risk of infection. Ulceration. Amputation.

Left untreated these things could result in irreversible damage which can result in amputation Raised blood sugar levels which promotes infection and delays healing Poor blood supply leading to tissue death and non healing wounds Decreased immunity and increased risk of infection and non healing Damage to the normal foot structure leading to deformity and trauma

Signs and Symptoms ISCHAEMIA. POOR MICROCIRCULATION. NARROWING/HARDENING OF BLOOD VESSELS. REDUCED BLOOD FLOW. GANGRENE. BLOOD CLOTS/ EMBOLI.

Poor blood flow Changes in skin colour: red, blue,white, purple, mottled, black may indicate a compromised blood supply Changes in skin temperature: cold to touch Pain or discomfort: a tightening sensation in the calf muscle that stops you walking is often indicative of a reduced blood supply Skin breakdown: Ulcers, chilblains, black patches Smoking will enhance these risks

Signs and symptoms NEUROPATHY LOSS OF FEELING. FOOT SHAPE CHANGES PAINFUL FEET. UNCONSCIOUS TRAUMA. DRY SKIN.

Loss of normal pain sensation ( NEUROPATHY) can lead to: Risk of unnoticed injury: cuts, ischaemic symptoms, fractures and infections Muscle wasting leading to clawing of toes and changes in foot structure: increased pressure and abnormal loading Loss of elasticity of skin and tendons causing tissue strain and abnormal foot function Reduced sweat gland function: dry skin fissures, callus formation and altered skin healing Pain: stabbing, burning, sharp or pins and needle like pain

THE CHARCOT FOOT: Presents as :RED / HOT / SWOLLEN Can lead to: DEFORMITY Associated with: DILATED VESSELS Therefore: INCREASED BLOOD FLOW In the presence of: LOSS OF PROTECTIVE FEELING Exacerbated by: LIMITED JOINT MOBILITY Leading to: ALTERED PRESSURES Requires immediate: NON-WEIGHT BEARING To prevent: FRACTURE / BONE REMODELLING Untreated it can lead to: A MISHAPED FOOT AT RISK OF ULCERATION AND AMPUTATION

A red hot foot needs URGENT attention Charcot foot Advice Inflammatory process associated with nerve damage Thin weakened bone structure Microfracture leads to bone remodelling Creates foot deformity Can be complicated by ulceration and infection Increases risk of amputation Contact the podiatry department or a health professional within 24hrs DO NOT weight bear/walk on the foot Consider risk of additional infection or other inflammatory process

CALLUS: TISSUE BREAKDOWN What is an ulcer? A NON HEALING WOUND. DEEP TISSUE BREAKDOWN Ulcer formation: ABSCESS BLISTER SINUS CALLUS: TISSUE BREAKDOWN CUTS

Ulceration Any break in the skin that has not healed within one week Can start from a blister, cut, dry skin fissure, under an area of hard skin or from a puncture wound/ trauma from a foreign object It can be superficial, a deep hole ( sinus ) or deep containing a collection of pus ( abscess ) Diabetic foot ulcers can quickly become infected Foot ulcers can take a long time to heal and can significantly disrupt your life 85% of foot/leg amputations are preceded by a foot ulcer

INFECTION: SIGNS AND SYMPTOMS INFECTION OF THE BONE BACTERIA:VISIBLE/INVSIBLE SWIFT PROGRESSION RISK OF AMPUTATION

Foot infections Caused by bacteria Best managed Are common in diabetic foot ulceration Spread fast Can affect deep tissues and bone Are not always visible/obvious Increase your risk of amputation Require urgent attention By an experienced practitioner May require long courses of antibiotics Improve with good blood sugar control and rest Can often be avoided with understanding of risk and taking preventative action

Warning signs! HEAT SWELLING REDNESS CHANGES IN COLOUR INCREASED SKIN TEMPERATURE NAUSEA/MALAISE FLUID LEAKING FROM WOUNDS/ CUTS PUS MOLODOUR/SMELL PAIN / DISCOMFORT INCREASE IN BLOOD SUGAR READINGS CHANGES IN SENSATION

Recognise what your feet normally look like and notice change! If in doubt check it out!!! Contact a health care professional for advice Act quickly: visit a walk in centre, out of hours doctor or A + E if the problem occurs at a weekend. Ask your podiatrist for an SOS access card: present this to the health professional should you develop a problem Be prepared if going on holiday: take a dressing pack and know how to access healthcare : don’t delay until your return home

WOUND CARE REPORT NON HEALING WOUNDS SWIFTLY SEEK ADVICE BEFORE STOPPING OR STARTING A TREATMENT/ ANTIBIOTICS ENSURE DRESSINGS ARE EFFECTIVE/WOUNDS COVERED TAKE ANTIBIOTICS AS PRESCRIBED (REPORT BAD REACTIONS) LIMIT ACTIVITY MONITOR BLOOD SUGARS REDUCE YOUR RISK FACTORS

Help promote healing Follow advice provided, ask if you are unclear about instructions A wound needs to be covered by a STERILE dressing at ALL times and changed if fluid is leaking through it. Antibiotic resistance is linked to unfinished courses of antibiotics Wounds need to be rested or offloaded in appropriate footwear Attend all your medical appointments

PHYSICAL WOUND PREVENTION INSPECT FEET DAILY WASH FEET DAILY MOISTURISE DAILY CHECK INSIDE SHOES ALWAYS FOLLOW ADVICE ATTEND FOOT APPOINTMENTS COVER WOUNDS WEAR RECOMMENDED FOOTWEAR STRETCH WEAR CLEAN SOCKS TAKE CARE ON HOLIDAY- WEAR SUNSCREEN

Make checking your feet part of your everyday routine Look out for: Cuts Swelling Red areas Pain

TAKE CAUTION… DON’T WALK BAREFOOT AVOID SHARP OBJECTS DON’T SELF TREAT WITHOUT ADVICE AVOID HOT THINGS NEAR FEET AVOID INNAPROPRIATE FOOTWEAR DON’T USE CORN PLASTERS TAKE CARE IN NEW ENVIRONMENTS REPORT FOOT SHAPE CHANGES

Common injuries and complications wounds Increased risks Walking barefoot Poor fitting footwear Self treatment, corn plasters Poor foot mechanics, deformity and weight bearing issues Compromised wound care/ infection Poor self care/ neglect Poor blood glucose control Inappropriate antibiotic or stopping of antibiotics Missed appointments Delay in seeking help Optimistic bias/ complacency

WHAT TO WATCH OUT FOR: holiday feet/ burns, ill fitting shoes, hot water, walking barefoot, unexpected objects, dry/ brittle skin.

Offloading vulnerable areas Loss of feeling in the feet and pressure occlusion of the blood vessels can lead to tissue damage and ulceration. Prevent pressure ulceration by keeping the weight off vulnerable areas when resting in one position for long periods of time.

Pressure damage Pressure damage can occur when blood flow is restricted to the tissues. People who have damage to the nerves won’t feel the discomfort that would normally encourage one to change position. People in hospital, on bed rest or with poor blood supply to the feet are also very at risk of pressure ulceration. It can occur from sitting or lying in one position for long periods or from pressure against bed ends or footwear. Heels, boarders of the feet and between the toes are the most vulnerable areas.

Footwear: protect your feet and don’t risk injury! Always wear footwear, don’t be tempted to walk barefoot Wear shoes that accommodate the shape of your foot Choose a protective upper adequate fastening and substantial sole Wear shoes and socks with a seamless design Always check your shoes for foreign objects lurking inside before putting them on

COMMON CONDITIONS: seek professional advice Fungal infections Corns Callus Verruca Blisters

8 steps to self help. Check Daily for skin changes. Apply moisturising cream daily. Don’t smoke. Avoid alcohol. Exercise regularly. Keep blood sugars well controlled. Follow footwear advice. Be aware of emergency contact numbers. 8 steps to self help.