Diabetic neuropathy Foot education

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Diabetic neuropathyFoot education
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Most foot problems are preventable

• Most foot problems are preventable through early
  identification and prompt treatment by skilled
  health professionals.

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Targeting education according to level of risk

• Wide spectrum of foot risk people require
  different levels of education
• Should be considered when providing footcare
  education
• Lifestyle changes only required for those at high
  risk

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Evidence-based stratification of services
Ulcer
High-risk foot clinic
Intensive foot education and podiatry
High
Neuropathy, previous amputation or ulcer
Peripheral vascular disease
Unable to feel monofilament
Neuropathy, no previous amputation or ulcer
Low
General information
No neuropathy
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• Which people should we target for footcare
  education?

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Footcare education

• Low risk
• simple advice
• no lifestyle change
• annual foot assessment
• High risk
• intensive education
• practical demonstrations
• significant behavioural changes
• focus on prevention

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Footcare education

• Which behaviour- and lifestyle-changing
  strategies do we teach people with diabetes when
  they are at high risk?

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Wash, touch and look at feet every day

• Do not soak feet
• Test water temperature
• Wash and dry between toes
• Avoid herbs and ointments
• Examine feet in good light

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Learn to look for

• Bruises
• Cuts
• Blisters

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Learn to look for
Cracked heels Callus
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Learn to look for
Hammer toe Clawed toes
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Learn to look for
Bunion Charcots arthropathy
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Learn to look for
Foot infection
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Learning to care for skin

• Moisturiser preferably in a pump bottle
• Massage with cream not in open sores or between
  toes
• Without perfume

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How to care for toenails

• Do not to let nail grow too long
• Cut straight across
• File sharp edges
• Ask a friend or relative

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How to treat tinea

• Anti-fungal lotion between toes
• Anti-fungal cream on feet
• Treat affected area and surrounding skin

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What to do about fungal nails

• Difficult to treat
• Thick nails should be filed

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What to look for in socks

• Wool or cotton
• Padded socks
• No tight tops
• No rough seams
• Knee-high stockings not advisable

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What to look for in a shoe

• Wide and deep at the toe
• Thick rubber sole
• No high heels
• Firm heel counter
• Lace-up or velcro
• Smooth lining

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Footwear
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When buying shoes

• Buy in the afternoon
• Measure both feet
• Stand up to fit
• Wear in slowly
• Never wear new shoes all day

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Being extra careful
Before putting on shoes, check for rough spots or
loose objects
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Preventing burns

• Use sunblock on exposed skin
• At least 3 m from heater
• Turn off electric blankets
• No hot water bottles
• Never walk barefoot

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Exercise

• Walk only as far as is absolutely necessary
• Non-walking exercises

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Identify problem and act quickly

• If no sign of improvement, contact doctor or
  emergency services

Remember, people with neuropathy do not feel
pain!
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Footcare educational material

• Written material complements education
• Written at average reading age
• Large font for visually impaired
• Pictures should be relevant to text

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Evaluating the foot education programme

• Evaluate behavioural change not knowledge
• How many times have you checked your feet this
  week?
• How many times have you put cream on your feet
  this week?

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Key messages

• Stratify people according to level of risk
• Educate those at high risk
• Shoes are the most common cause of ulceration
• Identify problems early and treat promptly
• Health professionals need to be trained in
  diabetic foot care

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Review question

• What are the three signs or symptoms of a foot
  with vascular disease?
•   a. Painless ulcer, warm foot,
  diminished pulse
• b. Painless ulcer, cold foot, bounding
  pulse
• c. Reduced hair, skin colouring normal
  to pale, warm foot
• d. Painful ulcer, cold foot,
  diminished pulse

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Review question

• Which of the following is NOT a desirable feature
  of shoes for people with diabetes and foot
  problems?
• a. Stable heel counter
• b. Two-inch heels
• c. Shock absorbent sole
• d. Deep toe box

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Review question

• Which statement is correct?
• In a severely ischaemic foot
•   a. Aggressive debridement of callus
  should be performed
• b. Doppler studies should be
  performed to determine blood flow to the
  foot
• c. Ulcers are usually in the areas of
  pressure
• d. Gel dressings should be used

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Review question

• Which of the following about foot ulceration in
  diabetes is NOT correct ?
• a. Neuropathic ulcer is characteristically
  very painful
• b. Neuropathic ulcer is surrounded by
  callus
• c. Pounding pulses are present in the feet
• d. Osteomyelitis is a common
  complication of diabetic foot ulcers

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Review question

• The cramping and pain in the legs associated with
  exercise is termed
• a. Night pain
• b. Intermittent claudication
• c. Rest pain
• d. Ischemic pain

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Answers

• d
• b
• b
• a
• b