Foot Care

 Caring for Your Feet

          Take care of your diabetes. Work with your health care team to keep your blood glucose in your   target range.

          Check your feet every day. Look at your bare feet for red spots, cuts, swelling, and blisters. If you cannot see the bottoms of your feet, use a mirror or ask someone for help.

          Be more active. Plan your physical activity program with your health team.

          Ask your doctor about Medicare. Coverage for special shoes.

          Wash your feet every day. Dry them carefully, especially between the toes.

          Keep your skin soft and smooth. Rub a thin coat of skin lotion over the tops and bottoms of your feet, but not between your toes.

          If you can see and reach your toenails, trim them when needed. Trim your toenails straight across and file the edges with an emery board or nail file.

          Wear shoes and socks at all times. Never walk barefoot. Wear comfortable shoes that fit well and protect your feet. Check inside your shoes before wearing them. Make sure the lining is smooth and there are no objects inside. 
Protect your feet from hot and cold. Wear shoes at the beach or on hot pavement. Don't put your feet into hot water. Test water before putting your feet in it just as you would before bathing a baby. Never use hot water bottles, heating pads, or electric blankets. You can burn your feet without realizing it. 
Keep the blood flowing to your feet. Put your feet up when sitting. Wiggle your toes and move your ankles up and down for 5 minutes, two (2) or three (3) times a day. Don't cross your legs for long periods of time. Don't smoke. 
Get started now. Begin taking good care of your feet today.  Set a time every day to check your feet.

     Risk Identification

Risk identification is fundamental for effective preventive management of the foot in people with diabetes. The risk of ulcers or amputations is increased in people who have had diabetes ≥10 years, are male, have poor glucose control, or have cardiovascular, retinal, or renal complications. The following foot-related risk conditions are associated with an increased risk of amputation: 

•          Peripheral neuropathy with loss of protective sensation
•          Altered biomechanics (in the presence of neuropathy)
•          Evidence of increased pressure (hemorrhage under a callus)
•          Bony deformity
•          Peripheral vascular disease (decreased or absent pedal pulses)
•          A history of ulcers or amputation
•          Severe nail pathology.

 Recommendations 

• All individuals with diabetes should receive an annual foot examination to identify high-risk foot conditions. This examination should include assessment of protective sensation, foot structure and biomechanics, vascular status, and skin integrity.
• People with one or more high-risk foot conditions should be evaluated more frequently for the development of additional risk factors.
• People with neuropathy should have a visual inspection of their feet at every visit with a health care professional.
• Evaluation of neurological status in the low-risk foot should include a quantitative somatosensory threshold test, using the Semmes-Weinstein 5.07 (10-g) monofilament.  
• Patients with diabetes and high-risk foot conditions should be educated regarding their risk factors and appropriate management. 
• Initial screening for peripheral vascular disease should include a history for claudication and an assessment of the pedal pulses. Consider obtaining an ABI, as many patients with PAD are asymptomatic.

 
 
  


References:
http://www.diabetes.org/living-with-diabetes/complications/foot-complications/foot-care.html                        http://care.diabetesjournals.org