Establishing adequate prevention in patients with diabetes is extremely important to avoid, control and minimize the appearance of diabetic foot and, therefore, its complications.
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The presence of diabetic foot is the most serious and costly complication among all that Diabetes Mellitus triggers. The existence of an ulceration can be in many cases, the principle of a major or minor amputation with the consequences that this implies.
Diabetic foot prevention program
It is demonstrated that with a well implemented prevention program , amputation rates can be reduced by 49-85%.
Without a doubt: Prescribing prevention in patients with diabetes, should be the first therapeutic option that we should sign and seal, to avoid diabetic foot.
The first thing that we must achieve is to make the patient with diabetes understand (always without being alarmists) the severity of his illness , how important it is to have a good control of it and the consequences that can be triggered , if the diagnosis becomes trivialized. Diabetes Mellitus .
Not all people with Diabetes Mellitus have the same risk of suffering diabetic foot, being the factors of greater risk the presence of:
- Peripheral neuropathy
- Deformities in the foot (bunions, claw toes, presence of bony prominences, ingrown toenails, etc.)
- Peripheral vascular disease.
- History of previous injury / ulceration or amputation.
Without forgetting, we also have other factors to control in patients with diabetes, because their presence added to those cited above, can multiply by four the possibility of developing some type of injury and therefore a diabetic foot such as:
- Present more than 10 years of evolution of his diabetes with poor metabolic control (high glycemia persistently).
- Bad hygienic habits of your feet.
- Use of inappropriate shoes.
- Smoking
- Obesity.
- Hypertension.
We are all clear at this point, that in order to control the diabetic foot it is essential to approach from a multidisciplinary team , where the patient with diabetes is one more of the team , because, but we get the diabetic patient is involved in their disease and control of it, I dare to say, that the prognosis of the diabetic foot will not be the most optimal.
Health professionals, we must instruct our diabetic patients (in a clear, understandable and individualized) improving their ability to control , teaching them to identify possible problems they may have in the foot and motivating them to have an active collaboration in their prevention .
Appropriate steps to follow
For this we must train their skills and instruct them in the appropriate steps to follow, such as:
- What basic care can be carried out at home and how they should be carried out.
- When they should go to the consultation.
- What should they do if they observe that they have an ulcer or if the ulcer that they have worsens their evolution.
- What are the risk factors that harm you?
- Among the existing therapeutic options, which are the most suitable for your ulcer.
- What should they do when the ulcer is closed and, above all, how to prevent them from having another one?
- How often should they go to the podiatrist to keep a good maintenance of their feet.
It is our responsibility to teach diabetes patients how to properly care for their foot.
Another parameter that we must take into account is that, on many occasions, when patients leave the clinic they do not remember anything more than a small portion of what is spoken. Therefore, it is important that this training is carried out in several sessions and we provide it in writing .
The use of different methods such as triptychs, photographs, phantoms, etc. In addition to helping us to give proper training to diabetic foot patients, they also help us to evaluate if the patient with diabetes has understood the content of the explained, if he is motivated to carry it out and if he has acquired the skills for his personal care.
The international diabetic foot group defines what are the points that must be addressed when instructing high-risk patients through a comprehensive foot care plan that includes:
- Treatment by professionals specialized in foot care (podiatrists).
- Skilled footwear specialized and properly prescribed ( not worth any footwear ).
- Health education of the patient.
PREVENTIVE MEASURES TO BE TAKEN BY THE PATIENT AT RISK OF HAVING DIABETIC FOOT:
1. Strict control of glucose
2. No smoking
3. Daily inspection of the feet
You need to check your feet daily, either directly or through the use of a mirror. Another option is for another person to check your feet, in case the person with diabetes can not do so or has visual disturbances.
It is best to always establish the same pattern: check back of the foot, examine well the interdigital areas and finally the sole of the foot. In this way, we can detect any variation in sample skin or nails early.
4. Periodic washing of the feet
Use warm water, about 37º. Check the temperature of the water before submerging the foot with a thermometer or with the elbow, to avoid burns.
5. Careful drying
With a fine towel, cellulose or toilet paper, especially in the interdigital areas or in the skin folds.
6. Do not use irritant products
Like callicides, alcohol, home remedies or blades to remove hardness and calluses.
7. Daily hydration
Avoiding the interdigital areas and the excess of creams that could cause the development of fungi in the feet.
8. Cut or file the nails in a straight line
With blunt scissors or straight tip pliers.
9. Calluses, hardness, thick or curved nails
They must be removed and checked by your podiatrist.
10. Do not walk barefoot at home or out of it
Always use appropriate footwear based on each terrain and circumstance.
11. Inspect the inside of the shoe before putting it on
Make sure with your hand that there is no object inside the shoe that could injure or trigger an ulcer.
12. Perform daily change of socks
Try to buy socks without internal seams or put them with the seams out (inside out), to avoid chafing. Use natural fabrics such as cotton, yarn or wool.
13. Do not wear tight shoes
Wear comfortable footwear, with rounded toe, wide in the forefoot (that respects the width of our foot), flexible back, with wide heel of 2-3 cm and sturdy soles with a good shank and adequate reinforcements, to help us to walk.
With some exceptions and always by prescription of your podiatrist, the footwear should not be able to bend as if it were a cloth.
14. Do not use electric blankets, heaters, hot water bags
It could burn.