Education in diabetic foot care
An important strategy in the management of diabetes is to teach patients and health professionals to reduce risk factors to reduce complications.
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Knowledge in diabetes education and prevention in foot care are essential to reduce complications; This knowledge must be transferred to the patient with diabetes so that they can use it to their benefit.
HOW to teach about foot care
• Before teaching foot care skills, the educator needs to assess the patient's current knowledge, behaviors, beliefs, and abilities to ask
Currently, what do you do to take care of your feet?
• The challenge for the educator is to provide information that adapts to the individual risk level of the patient and current practice of foot care.
• Having Parkinson's or blindness are situations in which the educator must adapt the special teachings to find solutions to the needs of these patients.
• Patients need to receive practical and realistic information about foot care. Give reasons why foot care is important and what is the purpose of the recommendations.
• It is useful for many patients to have written in their home the advice given by the diabetes educator.
• It helps the patient a lot that the information we transmit is personalized.
• It is essential to give the appropriate material at the cultural level that each patient has.
WHAT to teach about foot care
Teach the patient with diabetes the basic principles of foot care. Patients with neuropathy, vascular disease, or a history of foot ulceration or amputation should periodically be evaluated to see if they carry out the education received.
The feet of patients classified as high risk should be reviewed at each visit. Low risk patients will be reviewed and evaluated once a year. Patients should be encouraged to remove their shoes and socks at each health visit, even when they do not report anything abnormal on their feet.
Teach to check your feet: You should look between your fingers every day, when we put on or take off socks; A mirror can help examine difficult areas. Once the explanation is finished, the patient should be instructed to perform a demonstration of how to inspect the feet, indicating the areas that need special attention.
It is necessary to check the inside of the shoe daily to check its lining, seams etc, which may damage or irritate the skin; it is important to turn them over before putting them usually.
The shoes need to be spacious enough to accommodate any deformity we may have. Changing shoes throughout the day is an important help. Changing shoes during the day is a great help.
Avoid walking barefoot or walking in socks. Use proper footwear in swimming pools or beaches to avoid fungus or burns.
Wash and dry the feet very well, and especially between the fingers.
Those people who have maceration problems, place separators between the fingers.
To avoid burns because the water is very hot, the temperature of the bath or shower water should be checked with the forearm, elbow or a bath thermometer.
It is advisable, after the hygiene of the foot to apply a moisturizing cream except between the fingers and better that it does not carry alcohol, since it can dry out the skin a lot.
The nails of the toes must be cut straight to later use a cardboard file and not leave any spikes. If the patient does not see well or has difficulty reaching the feet, a member of their family, the nurse, or the podiatrist can do so.
Avoid hardness, calluses or toenails buried. Do not use chemicals, sharp instruments, or razor blades to treat problems as they can lead to ulcerations or infections.
Dress well and adapt: fluffy cotton, interdigital separators, synthetic blend, or wool socks. Avoid hot water bottles, electric blankets, heating, or microwaves because they can cause burns.
You should seek prompt medical attention for any problem: cuts, blisters, calluses, any wound that does not heal, or signs of infection, such as redness, swelling, pus, drainage, or fever.
The objectives
The professional will be able to:
• Identify sensitive peripheral points of autonomic and motor neuropathy of the foot.
• Identify signs of peripheral vascular disease in the lower extremities.
• List the basic elements by examining a diabetic foot.
• Explain why a high-risk foot can be classified.
• Describe treatment planning for a person with high risk foot or a sore on the foot.
The Complications
• Diabetic foot complications are costly, but beyond financial interests are the inevitable social and psychological anguish to patients and their families.
• Complications in the lower extremities are an important cause of hospitalization, disability, morbidity, and mortality among people with diabetes. Education in the prevention of ulceration or foot risk in diabetes would avoid important medical, social, and economic costs.
Important Educational Considerations
1. In patients susceptible to foot complications, education in diabetes and preventive care can reduce risks.
2. Meticulous foot care and proper patient education have been shown to reduce amputations associated with diabetes by 50%.
3. Teaching the patient and health professionals are ways to reduce risk factors and prevent the loss of limbs due to foot disease are important strategies to reduce costs.
4. Predicting which patients are the highest risk could lead to more effective use of resources.
5. For people without established complications of diabetes, better control in blood glucose levels has been shown to reduce the development of neuropathy.
6. According to the strategy of prevention, significantly improve glycemic control of the population with diabetes, thus lowering the incidence in risk factors and other complications, should be more effective in the prevention of ulceration and amputation of the foot , efforts that focus only on people already cataloged at high risk.
Neuropathy
Sensory, autonomic and motor neuropathy act synergistically to cause diabetic complications of the foot. Peripheral sensory polyneuropathy is an important pathophysiological risk factor for foot ulceration and amputation.
About 50% of people with diabetes of 15 years of evolution have peripheral sensory neuropathy. The loss of protective sensation allows the sensation of trauma to go unnoticed by the patient. The loss of protective sensation affects the fingers and toes first, although the functions of the motor sensor of the fingers of the hands can also be impaired.
A quick and easy way to identify feet without feeling protective is to assess the patient's ability to perceive the pressure of a monofilament 5.07 applied at the most common sites of potential ulceration. These sites are the plantar surface of the big toe and the fifth toe, the plantar metatarsal heads (first and fifth) and the heel.
Edema
Edema, is a local infection of systematic cause affecting the texture of the skin, skin circulation, or healing.
When edema is present it is wise to make the patient a clinical examination to determine the cause of the edema. If the edema is due to venous insufficiency alone, averages of rest are prescribed. If there is an arterial shortage, rest aids may be contraindicated or the amount of compression may need to be reduced. The elevation of the extremities on the heart can control the edema depending, if the person has fluid retention.
If the edema is due to congestive heart failure, it may indicate a need for a change in medication. In the event of cardiac arrest, reduction of edema due to elevation or compression of the leg can increase the return of the fluid and could potentially lead to volume overload. When blood flow is seriously compromised, patients may not be able to tolerate leg elevation and may even need to sit with their feet in a normal position to facilitate blood flow.
Trauma
A study conducted in 1990 of 80 amputations revealed that in 69 of the cases, the initial event of the precipitation were foreseeable minor traumas that led to ulceration.
Common sources of trauma include inappropriate shoes, claw toe nails, foreign objects, wrinkles in stockings or socks, barefoot walking, and inadequate cutting of fingernails, calluses, hardness, etc. Thermal injuries can occur by placing the foot in a bag or bottle of hot water, electric blanket or heating, or walking in the sand and hot pavements, resulting in severe burns to the foot.
Most skin ulcers are caused by minor, repetitive pressure with each step. Most amputations that result from trauma can be prevented with patient education and daily care.
Ulceration
An ulceration of the foot is a defect of the skin under the malleolus that penetrates the subcutaneous tissue.
Any injury to the foot of a person with diabetes is a cause for serious concern no matter the depth or size.
The proper education of a wound can cure many foot ulcers, and most amputations can be prevented.
Infection
The presence of purulence (pus), significant erythema, increased local heat, induration, or drainage indicate infection. If a diabetic foot injury is infected, appropriate oral or parenteral antimicrobial therapy is prescribed after the results of tissue culture are obtained. Acute infection without symptoms, gangrene, or osteomyelitis can be treated effectively by using a single oral antibiotic for 2 weeks, and daily wound care.
Patients with fever, leukocytosis, severe hyperglycemia, acidosis, hypotension, intense cellulitis, deep space infections, gangrene, evidence of osteomyelitis, would need inpatient therapy to receive parenteral antibiotics and surgical drainage if necessary.
Gangrene
Gangrene is a non-specific term for tissue death. The microbes that develop as a result of infection, or arteriosclerosis, or insufficient blood flow, vasculitis, resulting in tissue death or necrosis. Dry gangrene is associated with ischemia. When the gangrenous portion is sharply demarcated and affected in a small area, it can be left untreated, but observed closely.
A wet or wet gangrene is a sign of the process of progressive tissue death or that the infection may be involved. Due to complete obstruction of the flow of necrotic blood, surgical intervention is usually required.
