1. Footwear & Foot Care
Joanna Hammond
Specialist Podiatrist

2. Housekeeping: Fire alarms Mobiles Toilets

3. Aims How Diabetes and Vascular problems can affect the feet
Nail conditions
Foot conditions
Correct Footwear
Why correct footwear is so important

4. Pressure Points
An area which receives a high amount of pressure either whilst walking or from footwear.
Often occurs over bony areas.
If pressure continues, the skin could
- Form hard skin / corns.
- Break down, creating an ulcer.
- Blisters.

5. Pressure Points Contd
Bunions
Soles of the feet
Tops of the toes
Heels

6. Diabetes

7. Diabetes
Diabetes affects approximately 5% of the UK population (2.6 million diagnosed and estimated half a million undiagnosed) 90% of those are type 2 diabetics and 10% type 1. Peripheral Arterial Disease affects 19% of those aged over 70.

8. Diabetes and the Feet
Skin Changes
Blood Supply
Neuropathy
Ulceration

9. Skin Changes
Dryness, peeling and cracking can occur due to the natural function that provides moisture to the skin not being as efficient.

10. Blood supply to the feet
Poor circulation due to the narrowing and hardening of blood vessels to the lower limb, which can lead to poor healing and difficulty fighting infection.

11. Neuropathy
A lack of feeling within the feet, means that diabetics will not be aware of any injury unless they check their feet regularly.
Can be felt as tingling, burning, pricking, squeezing, “asleep”.
Can be worse at night

12. Ulceration Ulceration can be neuropathic or ischaemic or both.
12 – 25 % (cavanagh et al) of diabetics will develop an ulcer
85% of amputations start with an ulcer

13. Neuropathic ulcers – tend to be pain free found in areas of adequate blood flow, often surrounded by callus, commonly seen at the bottom of the feet and the tips of the toes
Ischaemic ulcers can be painful, are found in areas where there is a diminished pulse, often at the ends of the toes
Diabetic ulcers are usually a combination of these 2 types

14. Ulcers

15. Ulcer prevention Moisturise. Check feet daily. Don’t walk barefoot.
Ensure footwear is not rubbing or squeezing at any point.
If a wound is not healing normally contact a medical professional.

16. The Nail

17. Nail Anatomy
The nail is produced by cells in the nail matrix. If damage occurs to the cells, then a deformed nail will result.

18. Thickened Nails Usually as a result of damage to the nail bed.
These nails can look imposing.
File the surface in one direction, making sure you regularly check how much you have removed.

19. Fungal Nails
These nails are often crumbly and flake off in small chunks.
Cut a small section of the nail at a time and file all the rough edges.

20. Fungal Nails

21. Involuted Nails
The nail curls round, pushing on the sulcus (skin at the sides of the nail).
Many people, incorrectly, call these in growing toenails.
Gently cut a small section of the nail at a time following the line of the end of the toe.
Do NOT be tempted to dig down the side to remove the curled area.

22. Involuted Nail

23. In growing Toenail A small slither of nail pierces the skin.
It feels very sharp if the end of the toe is pressed.
Can become red, inflamed and infected.

24. Ingrowing Toenails
This occurs when a small spicule of nail pierces the skin surrounding the nail and grows into the flesh. It is extremely painful. Although any resultant infection can be initially managed with antibiotic cover, unless the spicule is removed, reinfection will occur

25. Black Nails More commonly caused by trauma.
Colour caused by a bleed under the nail (bruise).
Will grow out as the nail grows.
Can take 9 – 12 months to grow out.

26. Black Nails

27. Foot Conditions

28. Callus A build up of skin that occurs over areas of High Pressure.
Can be naturally occuring or footwear induced
It is often yellow in colour.
Gently file the area.
Moisturise Regularly.

29. Callus

30. Corns Small areas of very hard skin. Caused by Pressure. Have NO root.
Can be between the toes.
Do NOT use medicated corn preparations.

31. Corns

32. Corns
Severe untreated corns

33. Verrucae
This is a virus that infects one of the middle layers of the skin.
There are over 50 different types of verruca.
Management usually involves leaving asymptomatic VP’s, as they do resolve themselves naturally.
NB The black dots are not the virus!!!!!!!

34. Verrucae

35. Interdigital Maceration
White waterlogged skin between the toes.
Make sure you dry properly between the toes.
If necessary, apply a small amount of surgical spirit until the condition clears up.

36. Interdigital Maceration

37. Athletes Foot A Fungal Infection (there are 5 common types)
Can be between the toes, or anywhere on the foot.
The most common type gives the foot a distinctive demarcated redness called the moccasin affect.
Change socks daily, give shoes a day of rest.
Keep feet clean and dry.

38. Fungal Infections

39. Athletes Foot

40. Fissures Usually as a result of dry skin and tensile pressure
File the area
Apply moisturiser regularly
If necessary apply a dressing and monitor for signs of infection
May require Podiatric intervention of a large amount of callus is present within the fissure

41. Fissures

42. FOOTWEAR

43. Footwear is one of the main causes of foot problems.

44. Correct Size Many people wear the incorrect size of shoe.
Foot measurement is only a guide.
One study found that 35.5% of women wearing shoes too small reported foot pain (the figure was 9.5% for those wearing the correct fit)

45. Why?
Too big and shoes become a trip hazard, too tight and they cramp the foot making it unstable.

46. Heel Height This is the part that most people are aware of!
Shoes should be no more than half an inch.

47. Why? Too high and stability is reduced with the reduced foot / floor contact. The Centre of gravity is also altered!

48. Toe width
The shoe should be rounded to accommodate the shape of the toes.
Even slightly tapered toe boxes are not ideal.

49. Toe Depth The depth of the toe box should accommodate the toes.
If the toes are bent / deformed then a deeper toe box will be required.

50. Why?
A shallow toe box will rub on the tops of the toes causing corns, callus and discomfort.

51. Sole The sole should provide cushioning (without being too thick)
There should be some grip on the sole.

52. Why?
Too thin and every lump and bump can be felt on the ground potentially leading to instability.

53. Fastening All shoes should be held on the foot.
There should be a heel cup.
At the front there should be laces, a strap, buckle, velcro.
A slip-on shoe HAS to be too tight to stay on the foot!

54. Incorrect Footwear Incorrect Footwear can be uncomfortable.
It creates excessive Pressure Points.
It can lead to callus, corns or ulcers.

55. Footwear and Falls
Incorrect footwear is often a factor that contributes to instability and leads to falls.

56. Correct Footwear is one of the few areas in which you as individuals can improve your health outcomes.
Incorrect footwear is implicated in many falls.
Knowing the difference between good and bad footwear can reduce your risk of falling and ulceration.

57. Slippers
Exactly the same “rules” that apply for shoes apply for slippers.
Indoor shoes are as good as slippers.
Remember that if someone spends a lot of time indoors, then their slippers are their most important pair of “shoes”.

58. Thank You for Listening