Diabetic Footcare

Ultimate Prevention Report

Contents.
About The Author Why Are We Doing This? What Is A Footcare Assessment? What Would Have Been The Best Treatment? Shoes Usually Cause The Problem Another Factor To Consider With Shoes Is Swelling What Else Could Be Causing Problems To The Diabetic Foot? 3 4 4 5 6 7 8

About The Author.

Dominic Hough BSc DCh is a UK born Chiropodist who now lives in Canada with his wife Lucy and son Benjamin. He has worked with high risk patients within hospitals and health centers in the UK and Canada. He consults with medical companies on how to integrate footcare into their services. Writes regularly online about foot health issues and he works through the week at his clinic L&D Footcare:

Has written the Diabetic Footcare Bible:

The only book which actually explains how Diabetic patients can care for their feet properly and how they can pin point problematic areas even before they exist. Featuring print-outs and straight forward facts, advice and tips. The Diabetic Foot Care Bible is a MUST for all Diabetics who want to reduce the possibility of problems with their feet.

Why Are We Doing This?

Diabetes throughout the world is increasing. For different reasons this is occurring, but one thing that clinicians are noticing is that the increased prevalence in Diabetes and the longer that people are surviving the more that complications are being noticed and developed. Unfortunately Diabetes is very secret. 20% of all Non Insulin Dependent Diabetics have evidence of some sort of complication at the time of their diagnosis. Which usually means that Diabetes has been running rampant in the system for many months, if not years, before the diagnosis is even made. And even then, the tests for Diabetes are brought about by something irrelevant, like a routine blood test or an elderly person assessment. What happens though is that all the time Diabetes has been active it affects areas like the feet, eyes, internal organs and the nervous/ blood systems. Within people who have Diabetes, research has shown that Gangrene is a 50 times more likely than in a non Diabetic. Also there are many other conditions which cause ulcerations and the advice given here will actually help them- a bit of an overlap if you will. How many seminars and Doctor visits can patients go to, and still, people just do not get the importance of Diabetic footcare. Sometimes it can also be due to the clinician not being able to part knowledge because they are too busy or even (please no) they are not qualified to give that information that could be key to your footcare.

What Is A Footcare Assessment?

The system for assessing the feet is actually quite simple, practical, easy and quick to do. But here is the problem. Why are ulcerations, gangrene and high risk feet slipping through the system? Is it because of the assessments? Patient care? Patient lack of understanding? Poor clinician assessments? Why I say all this is because the assessment is quick, it is simple and it is free, yet there is still a failing. What we have seen is that the patient and the clinicians are usually to blame. Why? Because they do not look at the feet. In a clinic where I worked one patient was coming in and getting his right foot worked on- he has a pressure ulcer caused by poor footwear. One thing I noticed is that the clinician never looked at the left foot, they saw in the notes that the problem was with the right, so why waste time looking at the left? The patient was eager to get out of the clinic because it was

a weekly occurrence that lasted 20 minutes and he had been coming for the past 2 months. I asked for the left shoe to be removed. The clinician begrudgingly agreed and we found a nice deep ulcer starting in roughly the same place as the right foot. The patient explained that they wanted to see if this one was going to clear up. So even with the knowledge of what was going on with the right foot, the patient still did not comprehend the seriousness of a foot ulceration. Would they have said something? Eventually when things probably got much worse, but then the clinician should have looked at both feet each and every time regardless of present situations. Also to note is that some patients can be neuropathic, in other words, they can not feel parts or all of their foot. In this case the patient would not have known if they had a hole in their foot- they would not have felt it. The Diabetic Footcare Bible guides you through the exact steps to assess whether you are neuropathic or not (many clinicians do this step wrong)

What Would Have Been The Best Treatment ?

Using your eyes. One of the most easiest preventable treatment methods for a Diabetic, your eyes can detect what is good, what is different and what is bad. If you can't see your feet then either: get a family member/ carer to check them daily put a small mirror on the floor and check your feet that way

There is always a way. When you do check your feet your need to look in the danger areas: underneath your feet inbetween your toes on the out sides of your feet on the tips of your toes on the tops of your toes

These areas are specific to a quick look around the foot that you would do. Those above areas are prone to stress, pressure and changes in moisture. What are you looking for? Something that just doesn't look right. Luckily you have 2 feet so that you can check one foot against the other. Dry blood, discharge, open wounds, cuts and redness are all signs of a problem. Even hard skin and corns are signs of pressure problems which can develop into

ulcerations or at least painful sites if not dealt with professionally- also figuring out why you have them in the first place. Redness is a difficult one to manage because sometimes feet are red because they are warm. However when you have redness over toes, bone lumps etc then you know that there is a rubbing or pressure issue that needs to be addressed. What do you do if you found an ulcer? The Diabetic Footcare Bible explains everything that you need to do to identify, treat and monitor ulcerations and all your diabetic footcare problems.

Shoes Usually Cause The Problem

Shoes are one of the main causes of problems for most people, Diabetics especially. I believe that professionals are a bit to blame a bit for this because Diabetics are told to wear footwear all the time (just socks by themselves do not constitute footwear), so what does a patient do? Wear shoes all the time. However the clinicians fail to give appropriate advice on what type of shoes need to be worn, so the patient will wear what they deem appropriate. Now if you can not feel anything in your feet, which is a common complaint for many Diabetics, then any rubbing will not be picked up by your nerves. And the resultant small breaks in the skin are very common. Pressure problems from 1) tight shoes and from 2) tight shoes pressing into toes which then press into themselves is also very common. Also one area which hardly gets any attention is the addition of orthotics or any inserts into the shoe. Anything that gets put into a shoe automatically causes that shoe to loose its width and depth which obviously then makes the shoe smaller- causing rubbing etc. Also basic cushioning insoles, if not fitted properly, can ruffle and become hard where it curls up causing an area of high pressure. Also techniques used to stop slippage of the insole within the shoe range from odd to dangerous. A patient came into our clinic with their insole being held into their shoe by tacks. Now if there is red on the toes, especially if the redness is on the top, then nine times out of ten rubbing is occurring. We have had discussion after discussion with patients who refuse to believe that their shoes, which are expensive and fit perfectly are to blame. We all have to remember that are feet change shape over a period of time. They do not stay the same shape from when we were 10 years old to when we are 80 years old. So the size and style that you used to have might not be the style and shape that fits you now. Expense and shoe should never go hand in hand. A good fit is the best type of shoe, never the most expensive one. Even some reputable manufacturers are now starting to cave into public demand and stock shoes which are more geared towards fashion than function. So when professionals refer a patient to a preferred manufacturer some should not complain when a patient comes back with a different version of the problematic shoe. To ease this situation?

The patient/ clinician needs to have a look through the company's catalogue a physically circle the shoes which look like a decent shoe. The clinician then needs to list and describe the shoe that is required in detail- Velcro fastening, deeper depth, a wider width etc The patient needs then to buy the shoes but making sure that the shoes have a receipt and the patient/ store understands the return policy (usually within 30 days nonworn). The patient then needs to return to the clinician with those shoes and see whether they are suitable.

This sounds like overkill doesn't it? But when you are paying out for shoes you really need them to do their intended benefit without you having to buy more shoes. In one instance a patient bought 4 pairs of shoes over a one year period because they were hurting the tops of the toes. Unfortunately they did not want to give up on the court style shoe that they were buying- so even if she bought 50 pairs of shoes, they would still be wrong for her.

Another Factor To Consider With Shoes Is Swelling.

As you get older your feet tend to swell more. It is increased with females and with various conditions as well as medications. But swelling offers complications 4 fold: 1- Your feet get bigger- thus your shoes get smaller 2- Swelling leads to poor skin quality- a drier type of skin with a reduced quality of skin over all. This makes it much more likely for your skin to break as it's moist, elastic nature is reduced. 3- Healing tends to be reduced when you have more swollen legs and feet and in some instances foot and leg injuries, like venous ulcerations, can take a much longer time to heal. 4- We have found that patients with an excess amount of swelling- Oedema, usually can not feel too much within their feet. Sometimes this has to do with the swelling other times it has to do with the dryness of the skin with dulls light sensation. In the case of swelling feet sometimes more specialist shoes are required as commercial shoe shops do not stock shoes sizes or styles out of the normal range. This is where the clinician can help. They usually have access to specialized companies who do stock much wider and deeper shoes. Also as a side issue, clinicians can also arrange for patients to interact with other health professionals who could help to reduce the swelling- either through medication, massages, stocking therapy or compression bandages. The Diabetic Footcare Bible identifies the specific needs and factors that you need for a good shoe- even how to find the best Diabetic socks and prevention techniques.

What Else Could Be Causing Problems To The Diabetic Foot?

You tend to find that there are a host of problems (that can actually be fixed) that impinge on the healthy Diabetic foot. Now we have to understand that Diabetes is progressive, it gets worse as time increases, but sometimes we just focus on the wrong things: 1- Not needed illnesses. I like this one. Sometimes a clinician or patient will be so focused on their fungus nails that they do not want to acknowledge the issues at hand- the rubbing, callus or corns that are on their feet. We have had some patients really concerned about their fungus nails because of the previous clinician told them they need to have them sorted out. However they clearly failed to address the small corn that was inbetween their toes- which turned out to be an ulcer by the time they saw us. Lets get the topic out of the way first. A fungus nail is not really going to kill you. It might look unsightly and the nail might even become thickened- but that is about it. You can try to treat it with tablets (the best method, creams and paints do not work) but sometimes the tablets can interfere with other medications and can cause stomach upsets. Liver damage is rare but possible. But if the clinician is thinning out and cutting back your nail, then that is fine. Sometimes we have talked to death about fungus nails and tried to reassure the patient that it's OK. But still you find the patient will ask the same fungus problem again and again. I believe patients and some clinicians gets caught up in the infection word and they freak out, for a better word. Sometimes focusing on something else that is not a huge deal takes away the real concern- the feet and the their susceptibility to problems. 2- Trialing their own treatments. There is a reason why corn plasters are limited in sale. They cause many problems. They contain an acid which blasts the skin. Sure it can remove the corn, but it can also remove the good skin around it and cause a nice hole- especially if you can not handle the effects (poor circulation, poor nerve sensation, Diabetic, Rheumatoid etc). Yet still people buy the products. If you are a high risk patient- Diabetic etc, then you shouldn't be walking around in a bubble, but you should be careful. Homecare of your own feet is fine as long as you have had a health care professional assess that you are fine in doing so (not all Diabetics are high risk). If you have a corn then go to your health professional to sort it out. Corns are there for a reason and a good health care provider will get rid of it and then tell you why you are getting it and how to reduce it/ stop it from coming back. Doing your own DIY will just make the problem worse. 3- Who To Turn To. We always advocate the need for a patient to go to the best person qualified to

treat them. This sentence is fundamental because you can go to any clinician but are they actually qualified? One patient who turned up to our clinic when to a Beautician first who then directly put him into hospital a few weeks later. They could treat the person, but they was not qualified to do so. Even some footcare clinicians can not treat the foot in the best way possible. Some are specialized even further into sports, child foot care etc. So when you have an issue with your feet, who do you actually go to see? A Doctor? A foot specialist? It is always a good idea to know who your go to clinician is because if time is the ultimate factor in your footcare. The Diabetic Footcare Bible shows you exactly how to find the best clinician- and what they need to do to help you. 4- If You Have An Issue What Do The Clinicians Do? We are very open when it comes to our dressings and ulcer care. We give the ulcer 6 weeks. After that we assess and usually refer on. All clinicians and teams should have a cut off time to see if something is healing or not. How can they tell if something is healing? Quite easily, because there are flow sheets and diagrams which they can use that literally tells them on the state of the wound. If they do not have that, how on earth do they know if something is healing? For a patient it can seem a bit too much. They have an ulcer and it seems like they have had it for ages but nothing seems to be done. Your body is your body and really you have a right to know what people are doing to it. You are in your right to ask what is the short and long term treatment plan for your feet. In some cases it is to stop the area from getting worse because the problem is too far gone and sometimes surgery is not possible. Which is fair, but does the patient or their family know about this? In other situations sometimes the care staff can not alter the Doctors orders on dressings, which is bizarre because a wound can change weekly, not monthly. So where does that leave the patient- a wound that can not get better because of people not trained enough to alter the dressing regime. It is not always to do with wounds either. How about that corn or your hard skin that you have. What is going to get done about that? Are you going to go and see the clinician for years to remove a corn or is there a plan in place to introduce treatments that could remove the corn or at least lengthen the visits to the clinic. However in some instances the patient does not adhere to the actual treatment offered. There are many reasons for this: 1- They have tried it before in the past- it didn't work then so it's not going to work now. Unfortunately you tend to find that the previous treatment didn't work because the patient wasn't prepared in expectations, the treatment wasn't right at that time and more than likely it was a poor treatment. 2- The actual treatment means a little change in lifestyle

3- The patient might have to buy something to accommodate the treatment 4- The patient has to admit that there is something wrong. I think what I am trying to state is that clinicians can only work with patient who are open to helping themselves. Whereas patients need a clinician who is open and willing to accept and educate the needs of the patient and also realizing that the patient is actually the one in charge of their treatment. Once this occurs then major headway into quality patient care and the reduction of debilitating conditions that can now be realized. If you do have any concerns then it is always advisable to see a qualified clinician who is involved in Diabetic footcare. The Diabetic Footcare Bible outlines even more preventative techniques, tips, and advice for any Diabetic who are concerned about the effects that Diabetes will have on their feet. It also includes the top 11 questions our patients have come to us regarding their Diabetic footcare. All the best in your footcare needs.

Dominic Hough. http://www.diabetic-feet-careplan.com/