Title: Diabetic neuropathy Foot education
1Diabetic neuropathyFoot education
2Most foot problems are preventable
- Most foot problems are preventable through early
identification and prompt treatment by skilled
health professionals.
3Targeting education according to level of risk
- Wide spectrum of foot risk people require
different levels of education - Should be considered when providing footcare
education - Lifestyle changes only required for those at high
risk
4Evidence-based stratification of services
Ulcer
High-risk foot clinic
Intensive foot education and podiatry
High
Neuropathy, previous amputation or ulcer
Peripheral vascular disease
Unable to feel monofilament
Neuropathy, no previous amputation or ulcer
Low
General information
No neuropathy
5- Which people should we target for footcare
education?
6Footcare education
- Low risk
- simple advice
- no lifestyle change
- annual foot assessment
- High risk
- intensive education
- practical demonstrations
- significant behavioural changes
- focus on prevention
7Footcare education
- Which behaviour- and lifestyle-changing
strategies do we teach people with diabetes when
they are at high risk?
8Wash, touch and look at feet every day
- Do not soak feet
- Test water temperature
- Wash and dry between toes
- Avoid herbs and ointments
- Examine feet in good light
9Learn to look for
10Learn to look for
Cracked heels Callus
11Learn to look for
Hammer toe Clawed toes
12Learn to look for
Bunion Charcots arthropathy
13Learn to look for
Foot infection
14Learning to care for skin
- Moisturiser preferably in a pump bottle
- Massage with cream not in open sores or between
toes - Without perfume
15How to care for toenails
- Do not to let nail grow too long
- Cut straight across
- File sharp edges
- Ask a friend or relative
16How to treat tinea
- Anti-fungal lotion between toes
- Anti-fungal cream on feet
- Treat affected area and surrounding skin
17What to do about fungal nails
- Difficult to treat
- Thick nails should be filed
18What to look for in socks
- Wool or cotton
- Padded socks
- No tight tops
- No rough seams
- Knee-high stockings not advisable
19What to look for in a shoe
- Wide and deep at the toe
- Thick rubber sole
- No high heels
- Firm heel counter
- Lace-up or velcro
- Smooth lining
20Footwear
21When buying shoes
- Buy in the afternoon
- Measure both feet
- Stand up to fit
- Wear in slowly
- Never wear new shoes all day
22Being extra careful
Before putting on shoes, check for rough spots or
loose objects
23Preventing burns
- Use sunblock on exposed skin
- At least 3 m from heater
- Turn off electric blankets
- No hot water bottles
- Never walk barefoot
24Exercise
- Walk only as far as is absolutely necessary
- Non-walking exercises
25Identify problem and act quickly
- If no sign of improvement, contact doctor or
emergency services
Remember, people with neuropathy do not feel
pain!
26Footcare educational material
- Written material complements education
- Written at average reading age
- Large font for visually impaired
- Pictures should be relevant to text
27Evaluating the foot education programme
- Evaluate behavioural change not knowledge
- How many times have you checked your feet this
week? - How many times have you put cream on your feet
this week?
28Key messages
- Stratify people according to level of risk
- Educate those at high risk
- Shoes are the most common cause of ulceration
- Identify problems early and treat promptly
- Health professionals need to be trained in
diabetic foot care
29Review question
- What are the three signs or symptoms of a foot
with vascular disease? - a. Painless ulcer, warm foot,
diminished pulse - b. Painless ulcer, cold foot, bounding
pulse - c. Reduced hair, skin colouring normal
to pale, warm foot - d. Painful ulcer, cold foot,
diminished pulse
30Review question
- Which of the following is NOT a desirable feature
of shoes for people with diabetes and foot
problems? - a. Stable heel counter
- b. Two-inch heels
- c. Shock absorbent sole
- d. Deep toe box
31Review question
- Which statement is correct?
- In a severely ischaemic foot
- a. Aggressive debridement of callus
should be performed - b. Doppler studies should be
performed to determine blood flow to the
foot - c. Ulcers are usually in the areas of
pressure - d. Gel dressings should be used
32Review question
- Which of the following about foot ulceration in
diabetes is NOT correct ? - a. Neuropathic ulcer is characteristically
very painful - b. Neuropathic ulcer is surrounded by
callus - c. Pounding pulses are present in the feet
- d. Osteomyelitis is a common
complication of diabetic foot ulcers
33Review question
- The cramping and pain in the legs associated with
exercise is termed - a. Night pain
- b. Intermittent claudication
- c. Rest pain
- d. Ischemic pain
34Answers