1. 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

2. 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
DPMI Workforce Development – The Alfred Workforce Development Team June 2005

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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