1. Diabetes and Foot Care Wentworth-Douglass Hospital Wound Healing Institute & Foot Clinic Prepared by June Bernard-Kriegl RN, CWS, CFCN Wound Healing InstituteFoot Clinic

2. What is a Diabetic Foot Ulcer? An open area that develops on the foot of someone with Diabetes

3. Diabetic foot ulcers can be hard to heal. The most common reason for hospital admission in people with diabetes is INFECTED FOOT ULCERS. Foot ulcers can lead to amputations. More people die from diabetic foot ulcers than breast cancer! Why should you be concerned?

4. DON’T SMOKE – Nicotine constricts the arteries, decreasing circulation. Control your blood sugars - repetitive high sugars can cause nerve and arterial damage. Consider attending a Diabetes Support Group or taking classes for help. Diabetes Support Group Have your foot doctor check bruised calluses that might be hiding foot ulcers. Preventing Foot Ulcers

5. Wearing inappropriate shoes (heels, flip flops) Going barefoot Deformities Other foot and nail diseases (athlete’s foot, fungal nails and Charcot foot) Complications of Diabetes such as neuropathy and arterial disease –Neuropathy: nerve damage in feetNeuropathy –Arterial Disease: poor circulationArterial Disease What else will increase the risk of an ulcer?

6. Common areas for ulcers

7. How do ulcers start? a red spot from pressure a blister from tight shoes or not wearing socks a callous that gets very thick an injury sustained while walking barefoot pulling on a piece of peeling skin or trying to remove a callus with chemical agents trimming toenails and clipping skin by accident ongoing moisture between the toes

8. Caring for your feet Inspect your feet daily: If you see a blister, red area, darkened callus or a sore that hasn’t healed in a couple of days, you should call your doctor. Tell them you have a sore on your foot and need to be seen that same day. Keep your feet clean, dry and moisturized: Apply lotion (not between toes) and dry well between toes after bathing. Don’t wear shoes without socks and change socks when they become damp Take your shoes and socks off at your provider office visits Foot exams should be done regularly by your provider Nail Trimming - trim straight across, rounding edges with an emery board If you can’t reach your toes or see well, see a professional for nail trimming (especially if you have neuropathy or arterial disease)

9. If you can’t see the bottom of your feet, ask someone else to check or place hand mirror on floor and pass your foot over it. Wear shoes or slippers at all times. Wear water shoes at the beach – the sand is very hot and with many foreign objects. Do not use heating pads or hot water bottles on feet. Check inside shoes before putting them on. Check bath water temp before entering. Do not use chemicals or sharp instruments to remove calluses or corns See a foot doctor at least yearly Caring for your feet

10. Shoes and Orthotics Appropriate shoes: Inappropriate shoes: Shop for shoes at the end of the day when your feet are their largest. Make sure there is “wiggle room”/a deep toe box. Orthotics: Custom inserts can be made specifically for your foot to ease pressure and general inserts can be purchased as well.

11. More Information Our Foot Care Clinic is here to help youFoot Care Clinic answer any questions you may have. Please call (603) 740-2832 for more information. The Foot Care Clinic is located within the Wound Healing Institute at Wentworth-Douglass Hospital. Wound Healing Institute Wentworth-Douglass Hospital