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

2. “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.

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

4. 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

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

6. 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

7. 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

8. 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

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

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

11. 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

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

13. 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

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

15. 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

16. 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

17. 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

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

19. 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

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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

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

28. 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

29. 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

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

31. 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.

32. 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.

33. 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

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

35. 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.