Foot Care for People with Diabetes Module 4.1.2 Best Feet Forward Foot Care for People with Diabetes Produced by The Alfred Workforce Development Team on behalf of DHS Public Health - Diabetes Prevention and Management Initiative June 2005

Acknowledgements The foot diagrams and resources used in this presentation are adapted from Feet can last a life time. A health professionals guide to preventing diabetes foot problems. National Diabetes Education Program www.ndep.nih.gov/resources/health.htm DPMI Workforce Development – The Alfred Workforce Development Team June 2005

Common types of diabetes Age of onset Usually <40 Usually >40 Body weight Lean Usually obese Prone to ketoacidosis Yes No Medication Insulin essential Tablets and /or insulin Onset of symptoms Acute Gradual (may be asymptomatic) DPMI Workforce Development – The Alfred Workforce Development Team June 2005

Foot problems Decreased blood supply poor healing The feet can be affected by: Decreased blood supply poor healing Nerve damage loss of feeling High Blood Sugar levels decrease healing Foot care is very important for each person with diabetes, but especially if there is: Loss of feeling in your feet. Changes in the shape of your feet. Foot ulcers or sores that do not heal. Nerve damage can cause you to lose feeling in the feet. You may not feel a pebble inside your sock that is causing a sore. You may not feel a blister caused by poorly fitting shoes. Foot injuries such as these can cause ulcers which may lead to amputation. Keeping your blood glucose (sugar) in good control and taking care of your feet every day can help you avoid serious foot problems. DPMI Workforce Development – The Alfred Workforce Development Team June 2005

Assessment and awareness Regular assessment of feet is important to check for: Sense of feeling and pulses in the feet Foot problems/deformities or past history of foot ulcer If foot problems are present feet referral to a podiatrist is recommended. DPMI Workforce Development – The Alfred Workforce Development Team June 2005

Assessment and awareness Always be aware of High Risk Feet Loss of feeling Poor blood supply Past history of foot ulcer Source: Footcare in Diabetes Workbook for Health Professionals. Australian Diabetes Educators Association DPMI Workforce Development – The Alfred Workforce Development Team June 2005

Caring for the feet Check feet every day. Individuals may have serious foot problems, but feel no pain. Check feet for cuts, sores, red spots, swelling, and infected toenails. Make checking feet part of your every day routine. DPMI Workforce Development – The Alfred Workforce Development Team June 2005

Caring for the feet Wash feet every day Wash feet in warm, not hot, water. Do not soak because skin will get dry. Dry feet well. Be sure to dry between the toes. DPMI Workforce Development – The Alfred Workforce Development Team June 2005

Caring for the feet Rub a thin coat of skin lotion or cream. Keep the skin soft and smooth Rub a thin coat of skin lotion or cream. Do not put lotion or cream between toes DPMI Workforce Development – The Alfred Workforce Development Team June 2005

Caring for the feet Smooth corns and calluses gently. Check with the doctor/podiatrist before using a pumice stone. Use pumice stone after bathing or showering Don’t cut corns and calluses. Don't use razor blades, corn plasters, or liquid corn and callus removers - they can damage the skin. A pumice stone is a type of rock used to smooth the skin. Rub gently, only in one direction, to avoid tearing the skin. DPMI Workforce Development – The Alfred Workforce Development Team June 2005

Caring for the feet Toenails should be trimmed regularly With clippers after bath/shower. Straight across and smooth with an emery board or nail file. don't cut into the corners of the toenail. If toenails are thick or yellowed, or nails curve and grow into the skin, have a podiatrist trim them. DPMI Workforce Development – The Alfred Workforce Development Team June 2005

Preventing foot problems Protect the feet Wear shoes and socks at all times. Choose clean, lightly padded socks that fit well. Socks that have no seams are best Check the insides of shoes before putting them on to be sure the lining is smooth and that there are no objects in them. DPMI Workforce Development – The Alfred Workforce Development Team June 2005

Preventing foot problems Protect the feet Wear shoes that fit well and protect the feet. Athletic or walking shoes are good for daily wear. They support the feet and allow them to "breathe." Avoid vinyl or plastic shoes, because they don't stretch or "breathe." DPMI Workforce Development – The Alfred Workforce Development Team June 2005

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

Preventing foot problems Protect your feet from hot and cold. Keep your feet away from radiators and open fires. Do not use hot water bottles on feet. Lined boots are good in winter to keep your feet warm and socks at night Remember to use sunscreen on the top of your feet if outside. DPMI Workforce Development – The Alfred Workforce Development Team June 2005

Preventing foot problems Keep the blood flowing to the feet. Keep feet up when sitting. Exercises for the feet Wiggle toes for 5 minutes, 2 or 3 times a day Move ankles up and down and in and out. Don’t Cross legs Wear tight socks, elastic or rubber bands, or garters around your legs. Don't smoke Smoking reduces blood flow to feet. Control Blood glucose, blood pressure and cholesterol. DPMI Workforce Development – The Alfred Workforce Development Team June 2005

Healthy Eating Control blood glucose and blood fats Body weight Healthy food Regular carbohydrate High in fibre Low in fat (particularly saturated fat) Low in added sugar Adequate energy /protein/fluids/vits and mins DPMI Workforce Development – The Alfred Workforce Development Team June 2005

Exercise / Activity Increased insulin sensitivity 30 minutes moderate intensity on most days preferably all Helps to: Increased insulin sensitivity Decreased insulin requirements Weight reduction Lipid control Blood pressure control DPMI Workforce Development – The Alfred Workforce Development Team June 2005

Identification of a problem Daily inspection of the feet note: Broken skin Redness Swelling Corns/callus Black/blue areas Report to nurse/GP or podiatrist for assessment if you detect any of these problems DPMI Workforce Development – The Alfred Workforce Development Team June 2005

Prevention is better than cure! Prevention and early identification of foot problems can prevent foot ulcers and amputation Source: Footcare in Diabetes Workbook for Health Professionals. Australian Diabetes Educators Association DPMI Workforce Development – The Alfred Workforce Development Team June 2005