For people with diabetes, prevention and management of their feet is very important. According to the 2013 CDA Clinical Practice Guidelines, "Detectable sensorimotor polyneuropathy will develop within 10 years of the onset of diabetes in 40% to 50% of people with type 1 or type 2 diabetes". Peripheral neuropathy along with peripheral arterial disease predispose people to foot ulceration and infection which can lead to ulceration and sometimes amputation.
As a health care provider, a foot assessment should be done at least annually and more frequently for those at high risk.
Remember to "look, feel and ask..."
1. Skin: Is the skin dry or calloused?
2. Nails: Are nails well kept or un-kept?
3. Deformity: Have there been changes to the bony structure of the foot?
4. Foot wear: Does the patients' footwear fit properly?
5. Temperature: Is the foot hot or cool?
6. Range of Motion: Check the hallux range.
7. Sensation: Use a monofilament to test 10 sites on the foot. For instructions, click here
8. Sensation: Ask the following 4 questions:
9. Pedal Pulses: Are pulses present, absent or bounding?
10. Dependent rubor: This may be indicative of poor arterial flow or perfusion.
11. Erythema: This may be indicative of inflammation, infection or Charcot changes.
For a clinician's brochure on foot assessment, click here
For an online version of foot assessment, click here
If your patient has diabetes, it is very important to encourage daily foot care inspection.
Top Ten Daily Foot Care Tips
1. Inspect your feet daily. Look for any cuts, cracks in your skin, ingrown toenails, blisters, discoloured or infected areas, callouses, corns or warts.
2. Wash your feet in warm (not hot) water using a mild soap. Don't soak your feet as this can dry your skin.
3. Dry your feet well after washing, especially between your toes.
4. Apply lotion to your feet to prevent dry skin. Do not put lotion between your toes, as this is an ideal location for fungus or infections.
5. Clean any minor cuts or scratches with mild soap and water and cover with a dry dressing to legs.
6. Wear clean socks made of breathable materials (ie. cotton) that are not too tight around your legs.
7. Trim your toenails straight across and file any sharp edges. This will help prevent ingrown toenails.
8. Buy shoes at the end of the day when your feet are the biggest. Feet often swell during the day.
9. Do not go barefoot. Wear shoes at all times to prevent injury to your feet.
10. Wear socks at night if your feet feel cold. Do not use hot water bottles or heating pads as they may burn you.
Are you interested in providing a prevention workshop?
The Diabetes, Healthy Feet & You Program is available throughout the Waterloo Wellington region. This program is in collaboration with the Canadian Association of Wound Care (CAWC) and the Waterloo Wellington Self-Management Program. This 2 1/2 hour workshop is targeted to people with diabetes who are willing to learn more about foot care. For more information about this program, click here.
Management of Foot Ulcers
General principles of wound management involve:
1. Referral to a multidisciplinary health care team with expertise in the management of foot ulcers
2. The provision of a moist wound environment
3. Debridment of nonviable tissue (nonischemic wounds)
4. Offloading of pressure areas. For more information on the impact of offloading devices on diabetic foot ulcers, click here.
For More Information
If you would like to refer your patient for foot care, please complete a referral form and submit to Diabetes Central Intake, or if you prefer, the following chart identifies local foot care providers. Please note that service fees apply to most services listed.
For more information on services in Centre or North Wellington, please see below or click here.