One simple way you can impact the long-term complications of diabetes is to have your patients assume the responsibility to check their feet every day.
By Shelley Diamond, BScPhm
Illustration by Martin Bregman
Poor circulation, which can impair wound healing, combined with peripheral neuropathy, which can impair sensory nerves, sets up a potentially dangerous situation for undetected foot problems.
People with diabetes may not feel a foot injury, blister or cut. These can become infected and may lead to serious complications that eventually result in amputation. In fact, diabetes foot ulcers are the leading cause of amputation, however the majority of these could be avoided by early detection, regular foot checks, and appropriate wound care.
Diabetes foot infections are the number one reason for hospital admissions for people living with diabetes. At highest risk for amputation are those over 40, those who smoke, and those who have lived with the disease for at least 10 years.
Here are some tips you can provide to your patients based on recent recommendations from the Canadian Association of Wound Care and the Canadian Diabetes Association:
- Wash the feet daily, making sure they are dried well, especially between the toes. The feet should not be soaked as this may lead to extra dryness.
- Check for redness or blisters, which may indicate that shoes are not fitting properly. Cover sores or blisters with a bandage and see a healthcare professional as soon as possible.
- Apply an unscented lotion to the heels and soles of the feet but avoid applying between the toes.
- Patients who cannot reach their toes or do not have feeling in their feet should have their toes trimmed by a trained footcare professional.
- Advise your patients to shake out their shoes before putting them on to avoid stepping on a foreign object.
- Wear shoes at all times, indoors and out.
- Change socks every day. White socks are useful as it is easier to see any drainage that might occur with cuts and sores.
- When buying shoes, select those with closed toes. Avoid high heels, pointed-toe shoes and sandals. It is a good idea to buy shoes at the end of the day as this is when the feet tend to be swollen.
- Refer patients to a professional footwear specialist to ensure shoes are properly fitted.
When to get help
Your patients should be referred to a physician if they find redness, pain, swelling or warmth in the legs or feet. An annual visit should also be planned with their physician where their bare feet will be inspected. They will also be checked for neuropathy, using a monofilament, and also for loss of circulation.
A footcare specialist should be seen when patients have corns, calluses, in-grown toenails, warts, or slivers. They should not attempt to manage these on their own.
Your efforts to ensure patients check their feet daily and see their physician annually to examine their feet can truly make a significant difference. It may be important to engage a family member in the daily care if patients have visual problems, physical constraints limiting movement, or cognitive problems that impair their ability to assess the condition of the foot and to act upon any identified problems.
And of course, continue to recommend regular physical activity to improve circulation, remind patients to avoid smoking as it decreases circulation and healing, and encourage them to reach target blood glucose levels. The ability to avoid foot ulcers and amputations not only eliminates morbidity and disability but also the emotional and physical costs for people with diabetes. Imagine all of this potentially avoided with a simple check!
Shelley Diamond BScPhm is the president of Pedipharm Consultants and Diabetes Care Community Inc. (www.diabetescarecommunity.ca)