Doctor Reference

Foot deformities may be the result of diabetic motor neuropathy.

The function of intrinsic muscles is lost, causing the toe digits to buckle as other muscles become imbalanced. Muscle wasting occurs. The plantar fat pad becomes displaced and the metatarsal heads become more prominent. Limited joint mobility occurs and contributes to the potential for toe and foot injury. If Charcot foot is present, there are severe bone and joint changes and the foot is swollen and warm to the touch.

The more serious deformities are illustrated above. Prominent metatarsal heads are evidence of major deformity such as mid foot collapse.

Management Guidelines for Active Ulcer or Foot Infection

Never let patients with an open plantar ulcer walk out in their own shoes. Weight relief must be provided. Assess/prescribe therapeutic footwear to help modify weight bearing and protect the feet. Conduct frequent wound assessment and provide care as indicated. Demonstrate preventive self-care of the feet. Provide patient education on wound care. Refer to specialists and a diabetes educator as indicated. Certify Medicare patients for therapeutic footwear benefits. Place a High Risk Feet sticker on the medical record.

Patient Awareness

In Kenya, diabetic gangrene is a major cause of amputation*

Dr. Obimbo Moses M. et al. The Journal of Diabetic Foot Complications, Volume 2, Issue 1, No. 2, 2010

Putting your feet first!

Foot care is very important for each person with diabetes, but especially if you have:

Loss of feeling in your feet

Changes in the shape of your feet Foot ulcers or sores that do not heal

Tips for Proper Footwear

Proper footwear is very important for preventing serious foot problems. Athletic or walking shoes are good for daily wear. They support your feet and allow them to "breathe." Never wear vinyl or plastic shoes, because they don't stretch or "breathe." When buying shoes, make sure they are comfortable from the start and have enough room for your toes. Don't buy shoes with pointed toes or high heels. They put too much pressure on your toes.

10 tips to a healthy feet !

6 . Trim your toe nails each week or when needed. Trim your toenails straight across and file the edges with an emery board or nail file. 7. Wear shoes and socks at all times. Never walk bare foot! Wear comfortable shoes that fit well and protect your feet. Feel inside your shoes before putting them on each time to make sure the lining is smooth and there are no objects inside. 1. Take care of your diabetes. Keep your blood sugar within a good range 2. Check your feet every day. Look at your bare feet every day for cuts, blisters, red spots, and swelling. Use a mirror to check the bottoms of your feet or ask a family member for help if you have trouble seeing. 3. Wash your feet every day. Wash your feet in warm, not hot, water every day. Dry your feet well. Be sure to dry between the toes. 4. Keep the skin soft and smooth. Rub a thin coat of skin lotion over the tops and bottoms of your feet, but not between your toes. 5. Smooth corns and calluses gently. If your feet are at low risk for problems, use a pumice stone to smooth corns and calluses. Do nt use over-the-counter products or sharp objects on corns or calluses . 8. Protect you feet from hot and cold. Wear shoes at the beach or on hot pavement. Wear socks at night if your feet get cold. Dont test bath water with your feet. Dont use hot water bottles or heating pads. 9. 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, 2 or 3 times a day. Dont cross your legs for long periods of time. Dont smoke. Be more active 10. Check with your doctor. Have your doctor check your bare feet and find out whether you are likely to have serious foot problems. Remember that you may not feel the pain of an injury. Call your doctor right away if you find a cut, sore, blister, or bruise on your foot that does not begin to heal after one day. Follow your doctors advice about foot care.

Foot problems are very common in people with diabetes and can lead to serious complications!
As always, prevention is the best medicine
A good daily foot care regimen will help keep your feet healthy.

1. Wash your feet in warm (not hot) water, using a mild soap. Don t
soak your feet, as this can dry your skin. 2. While your feet are still wet, use a pumice stone to keep calluses under control. 3. Dry your feet carefully, especially between your toes. 4. Thoroughly check your feet and between your toes to make sure there are no cuts, cracks, ingrown toenails, blisters, etc. Use a hand mirror to see the bottom of your feet, or ask someone else to check them for you. 5. Clean cuts or scratches with mild soap and water, and cover with a dry dressing suitable for sensitive skin. 6. Trim your toenails straight across and file any sharp edges. Don t cut the nails too short. 7. Apply an odourless lotion to your heels and soles. Wipe off excess lotion that is not absorbed. Don t put lotion between your toes, as the excessive moisture can promote infection. 8. Wear fresh clean socks and well-fitting shoes every day. Whenever possible, wear white socks if you have a cut or sore, the drainage will be easy to see.

Diabetes affects the circulation and immune system, which in turn impairs the body s ability to heal itself. Over time, diabetes can damage sensory nerves (this is known as neuropathy ), especially in the hands and feet. As a result, people with diabetes are less likely to feel a foot injury, such as a blister or cut. Unnoticed and untreated, even small foot injuries can quickly become infected, potentially leading to serious complications.

Ensure that your foot care kit always contains: Nail clippers Nail file Lotion/ Moisturizer Pumice stone and Non-breakable hand mirror

In Kenya, 48% of patients suffer from diabetic foot ulcers*

You don t want to be one of them !

Dr. Obimbo Moses M. et al. The Journal of Diabetic Foot Complications, Volume 2, Issue 1, No. 2, 2010

Suffering from Diabetes?

Take adequate care of your feet
wear well-fitting shoes. They should be supportive, have low heels (less than 5 cm high) and should not rub or pinch. Shop at a reputable store with knowledgeable staff who can professionally fit your shoes. wear socks at night if your feet get cold. elevate your feet when you are sitting. wiggle your toes and move your ankles around for a few minutes several times a day to improve blood flow in your feet and legs. exercise regularly to improve circulation. inspect your feet daily and in particular, feel for skin temperature differences between your feet.

DO s

wear high heels, pointed-toe shoes, sandals (open toe or open heel) or worn-out shoes.

DON Ts

wear anything tight around your legs, such as tight socks or kneehighs. ever go barefoot, even indoors. Consider buying a pair of well-fitting shoes that are just for indoors. put hot water bottles or heating pads on your feet. cross your legs for long periods of time. smoke. Smoking decreases circulation and healing, and significantly increases the risks of amputation. have pedicures by non-healthcare professionals.

In case of Diabetes, your feet deserve better attention!

Are you giving your feet the required attention ?

Do you suffer from diabetes? Do you feel sensation at all the circled areas?

Examine yourself ! Tell your doctor to examine you!