Basic Footcare for high risk feet

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Basic Footcare for high risk feet

• A lecture for NHS staff
• Tutor Andy Neve Specialist Podiatrist
• E-mail andyneve_at_chiropods.co.uk
• Website www.chiropods.co.uk

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Foot Function?

• Locomotion
• Stability
• Cultural Aesthetic
• Foot Size Male Large Feet attractive
• Female Small Feet attractive
• Foot Shape Chinese Foot Binding

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Chinese Foot Binding or the Golden Lotus
Started in 900AD and finished completely in about
1949. Started at the age of 2-3 the ideal foot
length was 3-4 inches
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Are western societies any less obsessed with
changing foot shapes?
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Footwear Function

• Protection
• Weather, environment.
• Comfort
• Warmth, ventilation
• Functional for Activity
• Walking, Running, Sports, Social

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How the foot works

• Normal gait
• Controlled falling
• Shifting centre of gravity forward
• Feet and leg moves forward to prevent fall.
• Swing Phase
• Toe off dorsiflexion of ankle Supinate
• Stance Phase
• Heel Strike Mid Stance Pronate

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How Age affects function of feet

• Age related or Medical problems can lead to
• Ischaemia
• Neuropathy
• Foot Deformity
• Poor Tissue Viability
• Poor Gait

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Diabetic Foot Problems

• Foot ulceration 'diabetic foot' is the
  commonest reason for people with diabetes to be
  admitted to hospital in the UK. (Young MJ et al
  1994)
• Diabetic Foot problems take up more bed days than
  all the other complications put together (Waugh
  NR 1988)
• According to one widely cited study, people with
  diabetes are 15 times more likely to need
  amputation than people without the condition.
  (Bild DE et al 1989)

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What to look for?

• Check toenails, toes, in between toes Ball of the
  feet and heels
• Look for Blisters, fissures, wounds or ulcers
• Anything that may cause an opportunity for a
  bacterial infection

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Example of hidden infection/ulcer
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Referring patients to specialists

• Non healing wounds
• Medical staff Antibiotics, vascular team
• Nursing staff Dressing advice
• Tissue Viability Nurses New Ideas
• Diabetes?
• Diabetes Specialist Nurses
• Specialist Podiatrists
• Corns, Callus, Toenail Problems
• Hospital Podiatrists/Chiropodists while on ward
• Community Podiatrists/Chiropodists on discharge

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Sharp debridement by Specialist Diabetes
Podiatrist
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What to do about foot wounds?

• Establish cause if possible (etiology)
• Avoid cause if possible
• Antibiotics and Antimicrobial dressings if wound
  is infected
• Iodine or silver based
• If wound is sloughy use chemical debriders until
  base of wound is healthy red/pink granulation
  tissue
• Hydrocolloid like Aquacel to sloughy area only
• Intrasite or Purilon Gel

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Example of burn from a radiant heater
20th Jan 2005
24th March 2005
18th Aug 2005
19th May 2005
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NHS referral Criteria for Podiatry/Chiropody

• Priority are Foot Problems associated with
  medical conditions
• Ischaemia
• Diabetes
• Rheumatoid Arthritis
• Neuropathy/Neurological conditions
• Secondary are general patients with foot problems
  such as specific nail conditions corns or callus
  exacerbated by age related problems
• Not social nail cutting

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Products to avoid

• Corn and callus plasters/creams/solns
• Corn Knives
• Cheese grater type callus removers

• Contain Acids
• Can cause Ulceration
• Non sterile blade
• Can cause infections
• Too abrasive
• Can cause wounds

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Affects of Corn Plaster
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Products that can be safe

• Use wet and with soap
• Used daily such as Aqueous Cream BP
• Check Temp.
• Use for few minutes only
• Beware vibration mode
• Avoid ones with infra red lamp

• Pumice Stones
• Emollients
• Foot Spas

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Footwear Advice

• Good Shoe?
• Good Fit
• Length
• Width (Ball Toes)
• Depth
• Stable
• Supportive?
• Smooth internal seams
• Fastenings

• Bad Shoe?
• Poor Fit
• Too long or short
• Too narrow
• Too shallow
• Unstable
• Not Supportive?
• Rough internal seams
• No Fastenings

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Testing the fit of Shoes

• Template Method
• draw around foot onto card and cut out the
  outline and slide template into shoe to assess
  shoe fit
• Inner sole method
• Remove inner sole from shoe and stand on inner
  sole to assess overlap
• Main areas of fit Topline, Counter, Facings,
  Vamp, crease lines

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Check shoe from the side
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Heel design

• Heels should be as broad as the foot to aid
  stability
• Increased heel height adds pressure to the
  forefoot and increases the lumbar curvature of
  the spine to stay upright.
• Increased heel height reduces the need for a
  propulsive gait with dynamic foot function

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Heel wear
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Throat (topline)

• Entry point of foot into shoe
• Ease of entry is affected by style
• Fastening must be functional and adjustable
• Adjustment allows for swelling

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Distortion of the upper
Excessive pronation Note the hindfoot axis
distortion.
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Objective assessment

• Close fit at heel
• No gaping at topline
• No local tight spots
• Broad heel of suitable height
• Adequate width depth for 1st MP joint
• Functional fastening

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Remember High Risk Feet can deteriorate rapidly
18th August 2005
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3 weeks later after moist wound healing
techniques applied
8th September 2005
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Pt. Hospitalised for infection and BKA
26th January 2006 remaining foot started necrotic
heel ulcer unnoticed during hospital admission
for other legs BKA
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Summary

• Check skin of the feet for wounds
• Treat any open wounds
• Check footwear and give advice to patient, carers
  and family
• Refer on to specialists when necessary
• High Risk feet can deteriorate rapidly
• Always check both feet even if pt says its only
  my left one.