Professional Care:
A visit, at least annually to a foot care professional for a comprehensive
exam--and to perform focused interventions such as nail care or the paring of
calluses, is indicated for the asymptomatic patient who doesn’t have a high risk
foot (i.e. still has protective sensation, no foot deformities). For those at
high risk for ulceration (i.e. history of previous ulcer or amputation, presence
of foot deformities or they are experiencing a loss of protective sensation)
professional care visits will need to be more frequent.
Protective Footwear:
Many foot
ulcers are caused by poorly fitting shoes and socks. It is important to question
the patient about their footwear worn in the workplace, on special occasions and
inside the home. Medicare will pay for one pair of extra depth shoes and 3 pairs
of inserts annually, or one pair of custom molded shoes per year. They might not
be perceived as very glamorous but they can save your patients toes and feet.
Patients should shop for shoes later in the day, when the foot may be more
swollen and should look for an over-the-counter shoe with a high toe box (New
Balance athletic shoes are particularly good in this regard).
Pressure Reduction:
in addition to selecting footwear that avoids putting pressure over any bony
deformities, associated with motor neuropathic changes (i.e. claw and hammer
toes), pressure reduction may also be facilitated through the use of cushioned
insoles, custom orthotics and padded socks.
Prophylactic surgery
to correct
structural deformities such as bunions or hammer toes or metatarsal head
resection may be useful in decreasing pressure to a vulnerable area and thereby
reducing the risk for ulceration.
Patient education:
the patient or
their caregiver needs to be taught how to perform
daily
foot self-care and foot inspection. Daily assessment of the feet and lower
extremities is essential for early detection and prompt intervention of
potential problems. The patient must also be instructed on the importance of
controlling their blood sugars, following their diet, regular exercise, and
medication prescriptions.
At a
minimum, the patient or their caregiver should do the following:
look
and feel feet every day (using a mirror to see the bottom of the foot
can be helpful). Look for changes in temperature, breaks in the skin and
for reddened or darker areas. Areas that are especially susceptible are
those found between the toes. Patients should be instructed to contact
their health care provider the minute they see any thing unusual. They
should not try to treat this on their own. They should also be
instructed to wash their feet every day—and not to check the temperature
of bath water using their feet—nor should they soak their feet.
Instruct them to dry their feet thoroughly--especially the areas between
the toes.
Teach
them to apply a thin coat of fragrance free lotion to the foot and heel
area and instruct them not to apply between the toes.
For
those patients who have protective sensation, they may trim their own
toenails by cutting straight across and never down into the sides.
They
may also be taught to gently buff their corns and calluses with a pumice
stone after they have washed their feet. For those patients who have
lost protective sensation, have peripheral arterial disease or other
factors limiting their self-care abilities, they should receive their
nail care from a foot care professional.
Instruct patients to wear socks and shoes at all times and to never walk
barefoot--even inside their own home. An stress that it is important
they always feel inside their shoes before putting them on. Teach them
to avoid crossing their legs when sitting and to elevate them, unless
there is significant pain due to peripheral arterial disease when doing
this.
And be
sure to instruct the patient on smoking cessation strategies, if
applicable. |
|