Archive for the ‘Diabetic Foot Wear’ Category

Diabetic Footwear: If The Shoe Fits, Wear It

Friday, April 29th, 2016

When it comes to diabetic wound care, footwear matters – and proper diabetic patient shoe assessment is key.

Diabetic Footwear

 

Wound clinicians know how devastating foot amputations are for diabetic patients. But what you might not know is that a whopping 50% of diabetic foot amputations are a direct result of patients wearing improper footwear. Surprised? Unfortunately, this staggering statistic is accurate. But the good news is that there’s something we can do about it. If we get diabetic patients to wear the proper shoes, we can cut diabetic foot amputations in half.

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What is Charcot foot?

Thursday, January 1st, 2015

What is Charcot Arthropathy? Charcot foot, as it is commonly referred to, is a chronic progressive disease of the bone and joints found in the feet and ankles of Charcot_Footour diabetic patients with peripheral neuropathy.

What leads to this Charcot foot? Having long standing diabetes for greater than 10 years is one contributing factor. Having autonomic neuropathy leads to abnormal bone formation and having sensory neuropathy causes the insensate foot, or foot without sensation and thus susceptible to trauma, this is another contributing factor. These bones in the affected foot collapse and fracture becoming malformed without any major trauma. One common malformation you see related to Charcot foot is the “rocker bottom” where there is a “bulge” on the bottom of the foot where the bones have collapsed.

Your patient with Charcot foot will present with a painless, warm, reddened and swollen foot. You may see dependent rubor, bounding pedal pulses, and feel or hear crackling of the bones when moving the foot. If a patient were to continue to bear weight on the Charcot foot there is a high chance for ulceration that could potentially lead to infection and/or amputation.offloading_devices

Continued, on-going weight-bearing can result in a permanently deformed foot that is more prone to ulceration and breakdown. Prompt treatment is necessary using total contact casting, where no weight bearing will occur on the affected foot for 8-12 weeks. Our job as wound care clinicians is good foot assessment with prompt identification and treatment of this acute Charcot foot to prevent foot deformity and further complications in the diabetic patient.

 

Diabetic Patient Education

Monday, December 29th, 2014

Patient education plays a vital role in positive outcomes for our diabetic patient. Diabetic patients need to understand the importance of proper foot care and importance of good blood glucose control to maintain the integrity of their feet.

So what do our patients need to know? They need to work closely with their physician and the dietician to be sure their blood glucose levels are properly controlled. foot_mirror_between_toesThe ADA recommends an A1c below 7%.  They need to know how important it is to check their feet daily to catch any problems early. We as clinicians need to teach them how to do this and what to look for. Teach your diabetic patients to inspect their feet everyday. They can do this by having family members or caregivers check their feet, or they can use a mirror and do it themselves.

Explain to your patients what exactly they are looking for; cuts, sores, red spots, swelling, infected toenails, blisters, calluses, cracks, excessive dryness or any other abnormality. They should check all surfaces of the feet and toes carefully, at the same time each and every day. Explain to your patients to call their physician right away if they notice any abnormalities or any open areas. Other problems the diabetic patient should be aware of with their feet and report to their physician include tingling or burning sensation, pain in the feet, cracks in the skin, a change in the shape of their foot, or lack of sensation – they might not feel warm, cold, or touch. The patient should be aware that any of the above could potentially lead to diabetic foot ulcers.

Instruct your patients to wash their feet every day, but not soak their feet. Use warm, NOT hot water – be sure they check the water temperature with a thermometer or shoe_fittheir elbow. Dry feet well, especially between toes. Apply lotion on the tops and bottoms of their feet but not between toes. Trim toenails each week and as needed after bath / shower, trim nails straight across with clippers, smooth edges with emery board.

Wear socks and shoes at all times, the diabetic patient should never be barefoot, even indoors. Have them check their shoes prior to wearing, be sure there are no objects inside and the lining is smooth.  Instruct them to wear shoes that protect their feet; athletic shoes or walking shoes that are leather are best, be sure they fit their feet appropriately and accommodate the foot width and any foot deformities.

For our diabetic patients, glucose control is a key factor in keeping them healthy, but patient education and understanding of proper foot inspection and what findings to report to their physician are just as important for the well being of our diabetic patient.

Free Webinar “How-To: Diabetic Foot Exam Made Easy”. Use Promo Code: DFOOT  through 12/31/15.

Tips for Trimming Those Diabetic Toenails

Monday, December 8th, 2014

Make sure you have the proper tools. A set of toenail nippers, nail file, and orange stick are typically used.  Always follow your facility or healthcare’s settings policy for nail clip blog imagesinfection control. Single use disposable equipment is favorable.
Nails are easiest to trim after they have soaked for 10 minutes in a footbath to soften them. It is important to remember and educate our patients that the soaking of a diabetic patients feet should only be done by a healthcare professional. You can save some time by cleaning under the patient’s toenails with an orange stick wiping on a clean washcloth in between each toe while the feet are soaking.
After soaking and washing of the feet are completed, dry the patient’s feet completely. Wash your hands and put on new gloves to trim the toenails. Use your dominant hand to hold the nipper. Start with the small toe and work your way medial toward the great toe. Squeeze the nipper to make small nips to cut along the curve of the toenail. Be careful not to cut the skin. Use your index finger to block any flying nail fragments. Nippers are used like a pair of scissors – make small cuts, never cut the nail in one clip all the way across the nail. Never use two hands on the nipper. The nail is trimmed in small clips in a systematic manner. The nail should be cut level with the tips of the toes, never cut so short or to break the seal between the nail and the nail bed. The shape of the nail should be cut straight across and an emery board should be used to slightly round the edges. When filing nails always use long strokes in one direction, avoid using a back and forth sawing motion.
When all toes have been trimmed and filed, remove gloves and wash hands. Apply clean gloves and apply lotion to the top of the foot and to the bottom of the feet, rubbing lotion in well, wipe excess lotion off with a towel. Put patients socks and shoes back on as needed. Wash your hands again and smile, you are done!

FREE WEBINAR:  Skin and Nail Changes in the Diabetic Foot.  Click Here and use coupon code: NAILS through 12/31/15.

 

 

Diabetic Ulcers – Identification and Treatment

Monday, October 27th, 2014
Gail Hebert RN, BS, MS, CWCN, WCC, DWC, OMS, LNHA, Clinical Instructor

Gail Hebert RN, BS, MS, CWCN, WCC, DWC, OMS, LNHA, Clinical Instructor

Don’t miss this energetic webinar brought to you by Wound Care Education Institute®:  Another popular session recorded from the Wild On Wounds National Conference and providing continuing education credit.

Chronic foot ulcers in patients with diabetes cause substantial morbidity and may lead to amputation of a lower extremity and mortality. Accurate identification of underlying causes and co-morbidities are essential for planning treatment and approaches for optimal healing. In this one-hour recorded session, Gail Hebert will review evidence-based approaches for identification and treatment of chronic neuropathic, neuro-ischemic and ischemic diabetic foot ulcerations.

Wound Care Education Institute is featuring various webinars on topics from this years’ conference.  TO REGISTER CLICK HERE or visit www.wcei.net/webinars.

 

Diabetic Foot Ulcer Assessment and Hands On Lab

Wednesday, October 1st, 2014
Donna Sardina RN, MHA, WCC, DWC, OMS

Donna Sardina RN, MHA, WCC, DWC, OMS

Do you know the components of a Diabetic Foot Exam? It is so important that all of us in wound care know the steps to preventing foot ulcers on our diabetic patients.  And that starts with a routinely scheduled comprehensive foot exam.

Donna Sardina took us through all the aspects of a comprehensive exam during the pre-conference session “Diabetic Foot Assessment.”

The key word here is comprehensive. A proper exam involves much more than just a test of sensation using a Semmes Weinstein monofilament or a tuning fork. What about skin color, texture, temperature, foot deformities, nail deformities, glucose control, and critically important perfusion status. Did you know that it is estimated that 50% of amputations in diabetics are a direct result of improper footwear? That statement gets my attention every time I hear it.

In this session we learned how to examine our patient’s footwear for signs of trouble. Included in the handouts was a document “Diabetes: Shoe Fitting Tips” that will be extremely helpful when putting our knowledge into practice. In recognition of the fact that we are not all specialists in the diabetic foot, Donna shared a “Simplified Sixty Second Foot Screen” published by Dr. Sibbald in 2012. It is a validated tool that has just 10 items on it that can be completed in less than 60 seconds. This seminar was empowering to all who attended and gave us the tools we need to make a difference in this at risk population.

DFU_exam

“Footnotes on Selecting Diabetic Footwear”

Monday, January 28th, 2013

There are a lot of shoes out there, but not all of them would be appropriate selections for our diabetic patients.  In fact, selecting improper footwear could actually harm our diabetic patients and lead to diabetic foot ulcers and possible amputations.  Statistics show that 50% of amputations of our diabetic patients are directly related to improper footwear!amputation

Diabetic Wound Certified clinicians need to know how to check the footwear of our patients as well as the staff caring for our patients.  What are we looking for in a shoe for our diabetic patient?  The shoe should offer a firm snug fit.  The heel should be less than 1 inch, the greater the heel the greater the pressure on the ball of the foot and this could lead to callus formation and ulcerations.  The shoe should have laces, buckles or elastic to hold it in place.  When the diabetic is wearing slip on shoes the toes must curl to hold the shoe on and this can lead to calluses on the top of the toes and potential ulceration.  The shoe should have 1cm between the longest toe and the end of the shoe when the patient stands, we don’t want added pressure to the tips of the toes or on the toenails.  The sole of the shoe should be smooth without seams and cushioned to absorb shock and reduce pressure on the feet.  The shoe should be made from a material that “breathes”, avoid plastic and vinyl as they can encourage fungal infections.  The shoe should have a protective function; a closed toe shoe is imperative for our diabetic patient.  Look closely at the patients foot and the shoe – they should be the same shape, pointed toe shoes cause corns, calluses and ulcerations! Be sure the shoe width is appropriate, has a wide toe box that allow toes to move and accommodates any foot deformity.  The heel of the shoe should also be firm, you can check this by holding the sides of the heel of the shoe between your thumb and forefinger, try to push them together, if the heel compresses, its to soft and won’t give the patient good enough support when walking.

We also need to teach our patients and their family members instructions on checking for proper fit of their shoes and how to shop for new shoes.  They should be re-measured each time, shop late in the day, try on both shoes and walk around in them to ensure they are comfortable, be sure there is a thumbs width of space at the end of the longest toe, try the shoe on with the socks they will be wearing, be sure the heel is less than an inch, and be sure the shoe has laces or velcro closures.  If the patient has serious foot problems or deformities they should be referred for specially molded inserts and or shoes.

Following the above recommendations may just prevent a patient from developing a diabetic foot ulcer and an amputation!  Patient and caregiver education is a key factor in preventing diabetic foot ulcers!

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