Posts Tagged ‘Diabetic Foot Exam’

Diabetic Foot Screening Guide

Friday, July 29th, 2016

Five clinical tests for diagnosing loss of protective sensation in the diabetic foot, plus tips on inflammation assessment.

 

Diabetic Foot Screening Guide

 

How serious are diabetic foot ulcers? The statistics are sobering:

  • It is estimated that between 10 and 25% of patients with diabetes will develop a foot ulcer in their lifetime.
  • Diabetic foot ulcers precede 84% of all lower leg amputations.
  • The five-year mortality of patients with newly diagnosed diabetic foot ulcers (DFUs) is nearly 50%, and carries a worse prognosis than breast cancer, prostate cancer, or Hodgkin’s lymphoma.

In addition, DFUs are at increased risk for infections and other complications, and continue to be a major cause of hospitalizations and additional healthcare expenditures.  So while patients suffer greatly from DFUs, these chronic wounds are also a huge financial burden on healthcare systems. This is because these same patients spend more days in the hospital, and experience more visits to the emergency room and outpatient physician offices than other patients with diabetes.

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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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Really, How Important is that Monofilament Test?

Monday, January 26th, 2015

Neuropathy is one of the most common risk factors for lower extremity complications in our diabetic patients. With sensory neuropathy the patient has a loss of protective sensation that leads to a decrease in the ability for our diabetic patient to sense pain and temperature changes. This loss of protective sensation puts the patient at an increased risk for plantar foot injury. Unfortunately the patient may not feel the injury until significant complications have occurred.

The American Diabetes Association set up guidelines for us as healthcare professionals, these guidelines recommend screening in diabetic patients for neuropathy to check for loss of protective sensation on an annual basis, one way this can be done by doing the Semmes Weinstein Monofilament test. If the patient is found to have decreased sensation and is found to be at high risk the monofilament test should then be done quarterly.

The Semmes Weinstein 10g Monofilament is a test that checks for protective sensation in the diabetic foot.  It uses a 5.07 monofilament that exerts 10 grams of force when bowed into a C-shape against the skin for one second.  We don’t apply the filament directly to the ulcer site, callous, scar or necrotic tissue. Ask the patient to close their eyes during the exam and tell them to reply “yes” when the monofilament is felt, repeat without touching skin occasionally to be sure of patients response. Be sure to use random order on successive tests.

Areas to be tested include the dorsal midfoot, plantar aspect of the foot including pulp (fleshy mass on the distal plantar aspect) of the first, third, and fifth digits, the first, third and fifth metatarsal heads, the medial and lateral midfoot and at the calcaneus.  Record the results on the screening form, noting a “+” for sensation felt and a “-” for no sensation felt. The patient is said to have an “insensate foot” if they fail on retesting at just one or more sites on either foot.

Those patients who cannot feel the application of the monofilament to designated sites on the plantar surface of their feet have lost their “protective sensation”. Without this protective sensation the diabetic is now at increased for injury or ulceration. Neuropathy is usually noted in the first and third toes and then progresses to the first and third metatarsal heads.

Injury is much more likely to occur in the diabetic insensate foot at these areas and interventions must be implemented to protect the diabetic foot that is at risk for ulceration. Patient education and good “shoe fit assessment” will be part of our plan of care to protect the diabetic neuropathic patients foot.

 

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.

Diabetic Wound Certified Nurses Paying It Forward in Philadelphia

Tuesday, May 14th, 2013

Diabetic Wound Care certified nurses had a dream to create a free diabetic foot screening clinic and open it up to the city of Philadelphia, PA. Their dream came true.

Philadelphia Nursing Team, WCC's and DWC's getting ready to open up the clinic.

Philadelphia Nursing Team, WCC’s and DWC’s and Dr. Fanelly getting ready to open up the clinic.

Wound Care Education Institute’s (WCEI®) clinical team presented a session last year called “Paying It Forward” at our annual “Wild on Wounds” convention. This session was all about developing and coordinating free community diabetic foot screening clinics. We walked attendees through every step necessary to conduct such a clinic, from choosing a location to marketing and funding, and including logistics such as station supplies and staffing.

As a result, Stanley A. Rynkiewicz III RN MSN WCC® DWC® CCS and Administrator at Deer Meadows Home Health was inspired to coordinate a one day clinic in his home town of Philadelphia. He asked if WCEI could help him coordinate the event making it available to the whole city. We were thrilled at the invitation!

The event took place on Saturday May 11th with staff that included volunteer nurses, Wound Care Certified (WCC®) and Diabetic Wound Certified (DWC®) clinicians and a local podiatrist and co-sponsor, Dr. John M. Fanelly DPM.

The clinic was a huge success!  Close to 100 Philadelphians came from all over the community, ranging in age from 35-85 years.  We were a welcome sight to them and you could see the appreciation in their faces.  They came to us with conditions that ranged from calluses to fungus and included hammer toes, Onychogryphosis (also known as “ram’s horn nails”), diabetic ulcers and Charcot foot .

Polymem Silver Toe dressing to combat bioburden

Polymem Silver Toe dressing to combat bioburden

We will never forget Willie, an older man who walked with a slow shuffle and a big smile. Because he had not seen a doctor in many years, he was thrilled to have his feet checked. When he took off his slipper we saw the “ram’s horn toe nails” shown in this photo. They had not been cut in years and were excessively thick and curled under and over.

Ram Horn Nails

Ram Horn Nails

Our post clinic meeting discussions made it clear that our outreach work has just touched the surface of a great need. Much more needs to be done and our knowledge and expertise has the potential to have enormous impact. There are many more Willies out there that need our help.

We plan to share our experience in detail at this year’s Wild on Wounds annual convention in Las Vegas on September 11-14, 2013. Our hope is to inspire more clinicians to do this in their own communities across the country.

Thanks again to all the wonderful nurses who donated their time on a very long Saturday and to the wonderful sponsors:  Deer Meadows Home Health Select DataFerris Manufacturing (Polymem Dressings) / Dr. John M. Fanelly DPM and Wound Care Education Institute.

 

Know How to Perform a Complete Diabetic Foot Exam

Monday, August 1st, 2011
Diabetic Foot Exam
Jump to the Front Line: Know How To Perform a Complete Diabetic Foot Exam will be presented by Dr. Alison J. Garten DPM, CPed, Kaiser Permanente at this year’s Wild on Wounds National Conference in Las Vegas in September. This is a one-hour interactive session on learning and understanding the parts of a diabetic foot exam including the dermatological,vascular, neurological and orthopedic. We’ll review common areas of skin breakdown based on the different parts of the exam. See a thorough diabetic foot exam presented during this session. We’ll discuss patient examples of diabetic foot exams and learn how to easily spot areas prone to ulceration before they occur. Through this session you will learn the importance of a thorough diabetic foot exam
Be sure to check out this session as it sure to fill up quickly.

For more information about the Wound Care Education Institute, please visit http://www.wcei.net.

Click Here To Register for the Wild on Wounds National Conference