1. Produced by The Alfred Workforce Development Team on behalf of DHS Public Health - Diabetes Prevention and Management Initiative June 2005 Best Feet Forward Footcare for People with Diabetes Level 3 Module 4.1.2

2. DPMI Workforce Development – The Alfred Workforce Development Team 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

3. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Workshop purpose – Level 3 Target Aged care workers, HACC workers, consumers and carers Objective To provide training to increase skills in: Why people with diabetes are at risk of foot problems How to care for the feet of people with diabetes to prevent problems Identifying foot problems Action to take for foot problems

4. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Overview of diabetes Diabetes means that blood glucose in the body (often called blood sugar) is too high. Glucose comes from the food we eat Glucose is transported by the blood stream to all the cells in the body. G G G G G G G G G Muscle Bloodstream

5. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Overview of diabetes Insulin helps the glucose from food get into your cells. Insulin is a chemical (a hormone) made in a part of the body called the pancreas. Pancreas G G G G insulin Muscle

6. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Overview of diabetes If your body doesn't make enough insulin or if the insulin doesn't work the way it should, glucose can't get into cells. Glucose stays in the blood. Blood glucose levels get too high, causing diabetes. G G G G G G G G Muscle Bloodstream

7. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Common types of diabetes Type 1Type 2 Age of onsetUsually <40Usually >40 Body weightLeanUsually obese Prone to ketoacidosis YesNo MedicationInsulin essentialTablets and /or insulin Onset of symptoms AcuteGradual (may be asymptomatic)

8. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Treatment goals Symptom free Prevent short term complications Prevent long term complications Quality of life = Lifestyle focus

9. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Complications of diabetes Diabetes can cause increased risk of: Heart Problems Stroke Eye sight problems Kidney problems Foot problems

10. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Foot problems The feet can be affected by: Decreased blood supply poor healing Nerve damage loss of feeling High Blood Sugar levels decrease healing

11. 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.

12. 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

13. 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.

14. 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.

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

16. 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 Dont cut corns and calluses. Don't use razor blades, corn plasters, or liquid corn and callus removers - they can damage the skin.

17. 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.

18. 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.

19. 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."

20. 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.

21. 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.

22. 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. Dont 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.

23. 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

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

25. 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

26. 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