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Diabetic neuropathy Foot education

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* Due to biomechanical (structural) ... is one of the most common causes of cellulitis in people with diabetes. When carrying out a foot assessment, ... – PowerPoint PPT presentation

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Title: Diabetic neuropathy Foot education


1
Diabetic neuropathyFoot education
2
Most foot problems are preventable
  • Most foot problems are preventable through early
    identification and prompt treatment by skilled
    health professionals.

3
Targeting 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

4
Evidence-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?

6
Footcare education
  • Low risk
  • simple advice
  • no lifestyle change
  • annual foot assessment
  • High risk
  • intensive education
  • practical demonstrations
  • significant behavioural changes
  • focus on prevention

7
Footcare education
  • Which behaviour- and lifestyle-changing
    strategies do we teach people with diabetes when
    they are at high risk?

8
Wash, 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

9
Learn to look for
  • Bruises
  • Cuts
  • Blisters

10
Learn to look for
Cracked heels Callus
11
Learn to look for
Hammer toe Clawed toes
12
Learn to look for
Bunion Charcots arthropathy
13
Learn to look for
Foot infection
14
Learning to care for skin
  • Moisturiser preferably in a pump bottle
  • Massage with cream not in open sores or between
    toes
  • Without perfume

15
How to care for toenails
  • Do not to let nail grow too long
  • Cut straight across
  • File sharp edges
  • Ask a friend or relative

16
How to treat tinea
  • Anti-fungal lotion between toes
  • Anti-fungal cream on feet
  • Treat affected area and surrounding skin

17
What to do about fungal nails
  • Difficult to treat
  • Thick nails should be filed

18
What to look for in socks
  • Wool or cotton
  • Padded socks
  • No tight tops
  • No rough seams
  • Knee-high stockings not advisable

19
What 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

20
Footwear
21
When buying shoes
  • Buy in the afternoon
  • Measure both feet
  • Stand up to fit
  • Wear in slowly
  • Never wear new shoes all day

22
Being extra careful
Before putting on shoes, check for rough spots or
loose objects
23
Preventing burns
  • Use sunblock on exposed skin
  • At least 3 m from heater
  • Turn off electric blankets
  • No hot water bottles
  • Never walk barefoot

24
Exercise
  • Walk only as far as is absolutely necessary
  • Non-walking exercises

25
Identify problem and act quickly
  • If no sign of improvement, contact doctor or
    emergency services

Remember, people with neuropathy do not feel
pain!
26
Footcare educational material
  • Written material complements education
  • Written at average reading age
  • Large font for visually impaired
  • Pictures should be relevant to text

27
Evaluating 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?

28
Key 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

29
Review 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

30
Review 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

31
Review 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

32
Review 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

33
Review 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

34
Answers
  • d
  • b
  • b
  • a
  • b
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