TABLE OF CONTENT
The five key elements that underpin efforts to prevent diabetic foot ulcer:
Manydiabetic foot ulcer cases…1
Up to85%of lower extremity amputations…2
HOW CAN I IDENTIFY THE AT-RISK FOOT?
Early identification of at risk patients is key to effectively prevent diabetic foot complications
There are two major risk factors for patients with diabetes :
These need to be identified and monitored appropriately to minimise the risk of patients with diabetes developing a Diabetic Foot Ulcer. A daily foot check will help spot any foot problems.
Damage to the nerves (LOPS)
might be shown by:
- Tingling sensation or pins and needles, painful neuropathy
- Pain (burning)
- Less sweaty feet, Anhydrosis, dry feet and fissures especially around the heels
- Changes in the colour of the feet
- Changes in the shape of the feet
- Blisters and cuts
- Loss of feeling in the feet or legs i.e. parathesia, hyperaesthesia
Damage to the blood supply
might be shown by:
- Cramp in the calves (at rest or when walking). Intermittent claudication
- Shiny smooth skin
- Loss of hair on the legs and feet
- Cold, pale feet or cyanosis
- Changes in the skin colour of the feet
- Wounds or pressure sores that do not heal
- Pain in the foot or feet e.g. Ischaemic rest pain – especially at night
- Swollen feet
It is key to identify if these risk factors are present in your patients with diabetes
HOW CAN I IDENTIFY LOPS AND PAD?
How to identify the Loss of Protective Sensation (LOPS)
Performing a sensory foot examination will help you identify the degree of Loss of Protective Sensation (LOPS).
Ideally use a 10g (5.07 SemmesWeinstein) monofilamentDownload tips & tricks
How to identify Peripheral Artery Disease (PAD)
There are two major foot pulses:
the anterior tibial artery on the dorsum of the foot, and the posterior tibial artery behind the medium maleolus. If you can not palpate one of the pulses this indicates that your patient probably has PAD.
In that case, you should plan a vascular assessment to confirm it.
Depending on the presence of these risk factors we can classify the patients by level of risk and take the appropriate prevention steps.
What is my patient’s level of risk of developing a Diabetic Foot Ulcer (DFU) ?
There is an international classification to categorise the level of risk of your patients.
In addition, it is extremely important to identify a the level of risk of each patient with diabetes regularly. The criteria are very simple: LOPS, PAD, foot deformities, or past history of foot ulceration or lower-extremity amputation. Or end-stage renal disease.
This classification will provide you with the monitoring frequency required for each case, and the recommended specialist level of care.
No LOPS and No PAD, No History of ulceration / non traumatic lower limb amputation, or revascularization
Once a year
LOPS or PAD
Once every 6-12 months
General practitioner, podiatrist, diabetes nurse
LOPS + PAD or
LOPS + footdeformity or
PAD + footdeformity
Once every 3-6 months
Diabetologist, surgeon (general, orthopedic or foot), vascular specialist, podiatrist, diabetes nurse
LOPS or PAD and one or more of the following :
- History of a foot ulcer
- A lower-extremity amputation (minor or major)
- End-stage renal disease
Once every 1-3 months
Multi-disciplinary team specialized in diabetic foot care
In addition to regular risk assessment of your patient, it is key to look at the feet of your diabetes patient at each consultation.
Make the most of each consultation with your patients by educating them on diabetic foot complications prevention.
There are 4 steps you can teach your patients to keep their feet safe and prevent foot ulceration
Ensuring that their blood glucose is within the normal range throughout the day is the first step to prevent ulceration. Regulating their blood glucose within target will help your patients prevent or delay the progression of diabetic neuropathy and ischemia and ultimately preventing diabetic foot complications.
Daily foot check
Patients with diabetes should check their feet every day for cuts and wounds. Advise your patient to have a look at their feet when they put their socks and shoes on, or when they take them off. Any abnormal changes, and they should see a healthcare professional straight away. If they struggle to lift their feet up, then they might want to use a mirror the see the soles of their feet or seek help from family to check it for them. Any healthcare professional can perform a foot check during regular checkups.
DID YOU KNOW?
Remind your patients with diabetes that they should have a foot check at least once a year and arrange or refer to dedicated healthcare professional when appropriate.
Daily foot care
Your patients with diabetes should wash their feet daily in warm and dry them properly. Remind them to dry between their toes. Using emollient on legs and feet will help them prevent fissure from anhidrosis. Discourage the use of emollient between their toes or it may macerate and fissure between toes. Discourage hot water foot bath or steaming foot massage, these will cuase burn when diabetic neuropathy is unnoticed.
When it comes to footwear, this is what your patients with diabetes should know:
- To wear flat shoes that support their feet and accommodate their toes and foot deformity. Always check with hands examining the shoe size as potential insensate feet.
- Avoid shoes that are too small or pointed at the ends. Feel the shoes with hands, if their shoes are too tight, too loose or rubbing their feet then they should not wear them. Even if they look great.
- Avoid walking around barefoot.
- Discourage wearing nylon socks or tight socks. Encourage wearing light colour cotton socks for easy inspection.
- Advise your patient to examine their shoes, socks and stockings for damage or foreign objects each time before putting them on. Cracks, foreign bodies such as broken glass, small stones and nails inside their shoes can irritate and damage their skin and cause a DFU.
When it comes to diabetic foot complications, every day counts