Foot Care Chris Hamer, Chief Podiatrist

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Foot CareChris Hamer, Chief Podiatrist
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Introduction

• Diabetes is a lifelong disease, which can cause
  problems in the feet.
• These problems usually manifest themselves in two
  main areas
• Damage to nerves (affecting sensation)
• Damage to blood vessels (affecting circulation)
• It is vitally important to keep your diabetes
  under control.
• You should have a diabetic foot assessment at
  least annually.

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Role Of The Podiatrist In Diabetic Foot Care

• Prevention
• Education
• Treatment
• Assessment

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Assessment of the diabetic foot

• Each diabetic patient will be assessed
  individually as to their foot health, treatment
  and medical needs.
• The Podiatrist can utilize the following
  techniques and equipment to assess your foot
  health
• Observation includes mobility, dexterity, gait,
  skin, nails and any abnormalities.
• Dopplar equipment that uses ultrasound to
  record the velocity of the blood flow in the
  arteries. It is of use in determining ischaemia
  (poor circulation).

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Assessment of the diabetic foot (cont)

• Monofilament a fine filament, which when
  applied to the foot exerts a small pressure. It
  is of use in detecting any sensory loss
  (neuropathy).
• Neurotip a sharp/blunt instrument used when
  neuropathy is indicated.
• Cotton wool used to test patients ability to
  detect soft touch sensation.
• Tuning fork used to test vibration sensation in
  the foot. Vibration perception can be the first
  sensory response to be lost with neuropathy.

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Assessment of the diabetic foot (cont)

• Palpation of pulses
• Each foot has three pulses.
• Reduced or absent pulses can indicate peripheral
  vascular disease.

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Keeping your feet healthy

• Keep your feet clean by washing them daily.
• Dry them carefully with a soft towel, paying
  particular attention to drying between the toes.
  This helps prevent problems such as athletes foot
  and ulcers.
• Dry skin can be treated by applying moisturizing
  cream on a regular basis. Avoid using cream
  between the toes, as this can make the skin too
  moist and prone to infection.

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Keeping your feet healthy

• Cut your nails regularly. Follow the shape of
  the end of the toe when cutting. It is important
  not to cut the nails too short or down the sides.
• It is important not to walk barefoot, to avoid
  the risk of damaging your feet.
• Any minor cut, abrasion or blister should be
  covered until healed. A sterile dressing and
  tape should be sufficient. If any lesion is slow
  to heal seek immediate advice from your GP, Nurse
  or Podiatrist.

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Keeping your feet healthy

• If you suffer from neuropathy it may be difficult
  for you to differentiate between hot and cold.
  It is, therefore, important to be careful when
  bathing. Test the temperature of the water with
  your elbow or ask someone else to test for you.
• Remove hot water bottles from the bed before
  getting into bed. Do not use electric blankets.
• Avoid sitting too close to fires and heaters. It
  is easy to burn your skin without noticing.
  Also, be aware of car heaters being too hot on
  your legs.

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Keeping your feet healthy

• If you suffer from neuropathy it may be difficult
  for you to differentiate between hot and cold.
  It is, therefore, important to be careful when
  bathing. Test the temperature of the water with
  your elbow or ask someone else to test for you.
• Remove hot water bottles from the bed before
  getting into bed. Do not use electric blankets.
• Avoid sitting too close to fires and heaters. It
  is easy to burn your skin without noticing.
  Also, be aware of car heaters being too hot on
  your legs.

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Keeping your feet healthy

• Socks should be cotton or wool, be free from
  bulky seams and have non-elasticated tops.
• Before putting on socks and shoes check them for
  any foreign objects (stones, pins, splinters,
  bulky seams etc.) Wearing socks inside out helps
  prevent seams rubbing the skin.
• Never use propriety products, such as corn
  plasters, corn pastes and hard skin remover.

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Keeping your feet healthy

• Do not trim or cut any hard skin from your feet.
  The Podiatrist will do this if necessary.
• Your podiatrist will advise you on who should cut
  your toenails.

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Advice on foot wear

• When buying footwear
• Take the socks and/or insoles you anticipate
  wearing most often.
• Shop at stores with trained staff and that have a
  large selection of styles, sizes and fittings.
• Always try on both shoes.

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Advice on foot wear

• If your feet tend to swell, shop for shoes later
  in the day, when your feet may be swollen.
• For maximum comfort, buy a shoe with adjustable
  fastening, i.e. laces, Velcro, strap, buckle.

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Warning signs

• You are urged to check your feet on a daily
  basis.
• If you notice signs of the following, consult
  your Podiatrist or any other healthcare
  professional
• Infection
• Swelling
• Redness

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Warning signs

• Heat
• Pain
• Discolouration
• Change in shape
• Numbness

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Contact details

• The Podiatry Department can be contacted by
  writing to
• Podiatry
• Shetland NHS Board
• Lerwick Health Centre
• South Road
• Lerwick
• Or by telephone
• 01595 743317