Transcript Diabetes and foot care

Foot Care
By: Dr. Hala Al-Khalidi
Clinical pharmacy @ KAAU
Tuesday, November 15th, 2005.
Foot Care
Proper foot care should begin at early age to
develop healthy habits
 bone components mature until age ( F 14-16, M
15-21)
 Three groups:
1. Pediatrics  congenital malformation( juvenile
arthritis)
2. Adolesents  OA
3. Geriatrics  DM, RA, OA
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Causes of Foot
Problems
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Harmful foot practices as Scraping/ cutting corn’s
& Calluses
Improper trimming of toe nails
Opening blisters/ removing skin covers
Improper use of hot water
Potentially harmful home remidies (e.g. butter,
crisco, clorox, windex, gasolin, karosene)
Poor patient education/ awareness
After years of body weight bearing feet tend to
broaden, & flatten (F =30’s, M =40’s)
Foot Problems
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Sore aching feet
Ingrown toe nails
Corns & Calluses
Planter warts
Fungal infections
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A blister is an area of raised skin with a
watery liquid inside. Blisters form on hands
and feet from rubbing and pressure, but they
form a lot more quickly than calluses. You
can get blisters on your feet the same day
you wear uncomfortable or poor-fitting
shoes. You can get blisters on your hands if
you forget to wear protective gloves when
you're using a hammer, a shovel, or even
when you're riding a bike.
Gel Callus
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Lined with gel that
provides superior
protection for
sensitive toes.
Digi-Cushions
mold to the skin,
insulating toes
against shock and
pressure
Diabetes and foot care
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Because diabetes may keep you from feeling foot
problems, it is very important to:
look at your feet every day to check for things
like cuts, sores, ingrown or infected toenails, dry
cracked skin or swelling
wear shoes that fit well so you don't get blisters,
corns or bunions on your feet
ask your doctor to check your feet at each visit
Diabetes and foot care
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25% of patents with DM may develop
sever leg or foot problems are not just
painful, but dangerous
Diabetes can damage nerves. Patent might
not feel hot, cold or pain in there feet.
Little cuts or sores, if not cared for, can
then become deeper and bigger sores 
ulcers.
Diabetes and foot care
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This can be a very serious problem because
diabetes can also cause poor blood flow in legs
leading to poor sores healing.
If ulcers become infected (20%)more hospital
days then any infection, foot tissue starts to die
because of poor or no blood flow (gangrene) DM
pt. are 17 times more prone.
More then 50% of foot amputations could have
prevented through appropriate diabetes control,
(amputate) toes, foot or leg, & poor pt. education.
Diabetes and foot care
One in two PWD’s >10yrs
Will develop neuropathy = dec.
sensitivity + dec. pt.
awareness of minor trauma
 Continuous irritation ulcer
forms within 24 hrs
 Ill-fitting shoes  callus form
 inc. pressure on callus ischemia
& ulceration only seen if bleeding/
Odor is noticed from the wound
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Diabetes and foot care
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Diabetic foot ulcerations PVD (are 20x more
susptibale due to arterial insufficiency below the
knee ischemia
Uncontrolled DM  LDL & HDL  arterial
plaque = worsening circulation
Immunocompromised pt.s mobilization of
leukocytes , phagocytic ability, & O2 radical
production infection fight
Perepheral circulation= clearance of metabolic
waste, PH anaerobic infection @skin & nails
Diabetes and foot care
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Tack’s & pins were removed from foot ulcers
dec. sensation, & no daily inspections
Counseling a PWD about foot ulcers for safety
pt. should routinely see MD, & only superficial
foot ulcers should be tx. With topical Abx.
Cream, or ointments, with simple dressing
Erythema, local infection, & swelling need oral
Abx. For at least 10 days, change after C&S
Reduce pt. weight off the foot, & a 10 min
walk/day esp. if feet swollen or infected, cane/
wheelchair
Diabetes and foot care
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A 70% of deep foot infections are polymicrobial
& involve 3-5 MO
Aerobes= Staph. Aureus, staph. Epidermidis, &
streptococcus Sp.,
Anaerobes= bacteroides Sp., Peptococcus Sp., &
Clostridium perfringens
Gm(-ve) =E.Coli, proteus Sp., & Klebsiellas
Limb-threatning infections tx. Abx. Combo.+
bedrest + incision, drainage, & debridement of
foot ulcer
Diabetic Patient
Education
“If you look at your feet everyday, they will stay attached to
your ankles”
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Daily cleaning – drying (esp. between toe’s)
carefully- prevent irritation & breaking of skin
Moisturizers/ veg.oil, on skin not between toe
nails to prevent bact./ fungal infection
To soften toenails soak in warm-water + ½ tsp
(Na borate) moister around toenails, file nails
strait
Rubbing feet upward toward the tip of toe’s
Diabetic Patient
Education
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Varicose veins rub feet but not the legs
Elastic hosiery with tight top band, Crossing legs
may close blood supply to the legs not
recommended,  circulation
Take shoes off from time-time while traveling
place a pillow at the end of the bed
Avoid heating pads/ mod. Heat can injure the
skin with poor circulation
Treatment of Corns & Calluses
in Diabetic Foot
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Friction can form corns, & calluses, proper foot
wear is a must, stretching foot & legs a few times
a day, no high heels, are preventives
Soaking feet x15min – remove access tissue with
towel- file or medical sand paper – do not
irritate(no razor blade, or knives serious
infection & could be life threatning, uncontrolled
see MD
Do not use Salisylic acid (OTC),
can irritate skin
Skin Disorders
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Self-treatment measures should be supervised by
a physician
Reddness, cuts, blisters, pain, or swelling should
se a physician
To prevent ulcers, further infections, & gangrenes
Athletes foot= is peeling, +/- itching around, &
between toe’s, infected by Tinea Unguium
Infection of the toe nail characteristic by brittle
discolored nail beds
Skin Disorders
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PWD’s should not use strong antiseptics as
tincture of iodine can dry & irritate skin
Gauze bandage, Cellulose tape (scotch
tape), if needed to cover the wound, if
adhesive tape skin soggy & MO &
infection, plus irritate skin when removed
Poor Circulation
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Symptoms= cold, numbness, tingling, burning, or
fatigue
Discolored, dry skin, absence of hair on leg’s, &
feet, cramping, & tingling of leg muscles
Patients complaining of aching calves during
walking, need to hang feet over bed see MD
Possible blockage (clot) of circulation coldness
in one foot, one lower leg or foot will appear
larger then the other, with waxy appearance, no
hair growth, & thick nails, consult MD
Poor Circulation
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Daily foot bath- dry
patting- foot cream
(retian moister) 
softer brittle toe
nails for clipping &
filing
Keep foot warm
with moderate
exercise every day
Arthritis
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OA = non-inflammatory, DJD,
occurs 1ry in older population, &
a 2ry complication in athletics
injury in late teens/ early twenties
Hallux limitus or rigidus of the
big toe, stiffness, & spur
formation (metatarsophalangeal
joint) difficulty in fitting shoes
Padding shoes + insoles protect
feet from hard surfacw
Regular examination by
podiatrist
Ingrown Toenails
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A nail presses into the soft tissue of nail groove of
the toe pain, swelling, & ulceration
Incorrect trimming of toe nails, & to correct cut
strait across, with out tapering corners
Opportunistic resident foot bact.+ ingrown nail =
skin infection
FDA recommendation; Na sulfide soften keratin
in nails, & tannic acid hardens, & shrinks skin
surrounding the nail, by placing a medicated
cotton on the side of the nail, no > 7 days
Foot toe cap temporarily
Tips
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Some tips for buying shoes that protect your
foot health, home & out leave on & check
Size Have both of your feet measured every
time you buy shoes only leather soft, since
your feet may not be the same size, choose
shoes that are 1/2 inch longer than your
longest toe.
Blisters, ulcers and bunions are often linked
to shoes that are too small, Buy shoes late in
the day as feet tend to swell (edema).
Tips
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Because diabetes may keep you from feeling
foot problems, it is very important to:
look at your feet every day to check for things
like cuts, sores, ingrown or infected toenails,
dry cracked skin or swelling
wear shoes that fit well so you don't get
blisters, corns or bunions on your feet
ask your doctor to check your feet at each
visit