1. Foot care Diabetes Outreach (June 2011)

2. 2 Foot care Learning objectives >To understand peripheral vascular disease (PVD) >To understand neuropathy (nerve disease) >To be able to undertake a basic foot assessment >To be aware of the important factors for prevention of foot problems.

3. 3 >The risk of PVD increases with the duration of diabetes. >Other risk factors include hyperglycaemia, smoking, hypertension and hyperlipidaemia. >PVD is associated with a 2-4 fold increased risk of amputation. >All people with diabetes should be regularly screened for PVD. Peripheral vascular disease (PVD)

4. 4 >foot pulses (diminished/absent) >claudication (pain in the back of the leg) >intermittent >at rest and/or nocturnal >shiny appearance of skin >bluish discolouration of skin >loss of hair on feet and toes >failure of a wound to heal/gangrene >leg colour slow to return after elevation >significant temperature difference between leg and foot. Signs and symptoms PVD

5. 5 Peripheral neuropathy Peripheral neuropathy is a major underlying risk factor for the development of ulcers. Neuropathy is more common as the duration of diabetes increases. There is abnormal/reduced feeling which can lead to; > painless callus/corn formation > painless injuries > changes in shape of foot.

6. 6 Neuropathy: signs and symptoms >abnormal, decreased or increased sensitivity >loss of deep tendon reflexes >loss of vibratory, cutaneous pressure, temperature or position sense >heavy callus formation over pressure points >trophic ulcers >foot drop >changes in shape of foot.

7. 7 Foot risk assessment and management Five key elements >regular inspection and examination of the feet by health care providers >identification of the foot at risk >education of the person, family and health care providers >appropriate foot wear >treatment of non-ulcerative pathology.

8. 8 Assessment >diabetes control >blood vessel changes >sensation changes >mechanical factors >condition of skin and nails >previous problems.

9. 9 Daily care >wash and dry feet daily >inspect for signs of injury or pressure >moisturise dry skin >treat minor skin damage >trim toe nails.

10. 10 Foot care in hospitals >close observation >protect and cushion bony protuberances, ankle bones, heels, ‘bunions’ >use lambskin boots, protectors, foam, air pillows and inform theatre nurse >2/24 hour pressure care if immobile >keep feet warm with socks or boots >wash and dry thoroughly, attend to foot care >slippers on if ambulant.

11. 11 Prevention >patient education/staff education >daily inspection/assessment >smoking >avoid commercial corn & callus treatments >avoid electric blankets, hot water bottles or microwave bean bags if at risk feet.

12. 12 Prevention >encourage good supportive shoes >avoid walking bare-foot (if at risk foot) >wool or cotton socks >do not use garters or tight socks >pressure area care when in hospital.

13. 13 Foot ulcers >improve circulation >early antibiotics >debridement >specialist wound management.

14. 14 Case discussion >Johnny is 45 years old and has had type 2 diabetes for 15 years. Your assessment identifies that he has neuropathy. >Using the proforma for a foot care protection plan on the next slide map out the key points for Johnny. >Is there any other information about Johnny that you require?

15. My Foot Care Protection Plan AssessmentPotential problemsAction Feeling Blood supply Skin and nails Foot structure Footwear 15

16. References >Diabetes Outreach (2009) Diabetes Manual, Section 6: Footcare. 16

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