In general, who is at risk for developing foot problems?
Family history of foot disorders such as flat feet, hammer toes, and gait abnormalities
Personal history of previous ulcer/amputation ex: Diabetic foot wounds often located at pressure points
Personal history of callus formation on plantar surface of foot
What are the criteria for therapeutic footwear in the DM population?
1. History of partial or complete foot amputation
2. History of previous foot ulceration
3. Current foot ulceration
4. Foot deformity
5. History of pre-ulcerative callus formation
6. Documented neuropathy of callus formation
7. Poor or impaired circulatio
What are the 6 risk factors for developing peripheral vascular disease?
1. Family history of PVD
2. Advanced age
3. Smoking
4. HTN
5. Hyperlipidemia
6. DM
What are the 5 S/S of PVD?
1. Decreased skin temperature
2. Shiny, taut, thin epidermis
3. Hair loss
4. Thickened nails
5. Pale or ischemic color in feet
What are the 5 S/S of PVD?
1. Decreased temperature
2. Shiny, taut, thin epidermis
3. Decreased hair
4. Thickened nails
5. Pale or ischemic color in feet
4 Medical Conditions that are indicative of a refferal
1. Peripheral vascular
disease
2. End stage renal disease (on dialysis)
3. Tobacco Abuse
4. DM
- Poorly controlled diabetes (HgbA1C > 9%)
- Diabetic > 10 years
- Diabetic retinopathy
4 Medical Conditions that are indicative of a refferal
1. Peripheral vascular disease
2. End stage renal disease (on dialysis)
3. Tobacco Abuse
4. DM
- Poorly controlled diabetes (HgbA1C > 9%)
- Diabetic > 10 years
- Diabetic retinopathy
Which medical condition put people at the HIGHEST risk for developing foot problems?
DM!
- Poorly controlled diabetes (HgbA1C > 9%)
- Diabetic > 10 years
- Diabetic retinopathy
Which medical hx/conditions put people at a HIGHER risk for developing foot problems?
End stage renal disease (on dialysis)
Tobacco Use
Obesity
Gout
Anticoagulation (warfarin therapy)
Raynaud's disease/Scleroderma
Arthritis
Charcot Marie Tooth Disease
Paraneoplastic disorders
HIV/AIDs and related drug therapies
What are the 7 things you need to do to preform proper foot care?
1. Daily inspection
2. Daily cleansing with soap/water
3. Daily moisturizing except between toes
4. Absorbent foot powder especially if maceration between toes is a problem
5. Socks: Change when damp
6. Proper footwear
7. Never walk barefoot, even indoors
What are the 5 steps of LEAP? SEISM
1. Annual Foot Screening
2. Patient Education
3. Daily Self-Inspection
4. Footwear Selection
5. Management of Simple Foot Problems
What are the 4 best ways to prevent foot injury?
1. Use protective shin guards when working around the house or yard
2. Wear warm socks during cold weather to prevent vasoconstriction
3. Use hand or elbow checks of water temperature before bathing
4. Do not use chemical agents such as corn removers unle
When preforming daily foot inspection, what 3 things should you consider?
1. Using a mirror to check
bottom of feet
2. Use family member if you have vision problem
3. Look for scratches, cuts, fissures, blisters, sores, swelling, redness
1. Using a mirror to check bottom of feet
2. Use family member if you have vision problem
3. Look for scratches, cuts, fissures, blisters, sores, swelling, redness
When preforming daily foot inspection, what 3 things should you consider?
What are the 5 most important things to do when cutting nails?
1. Cut toenails after bathing
2. Cut straight across or shaped to follow contour of foot
3. Smooth the corners with an emery board or nail file
4. Do not cut into the corners of the toenail
5. Don't cut too short (Leave 1/16 to 1/8 inch of nail)
When should one seek out a HCP for nail care?
Cannot see or feel feet
Cannot reach feet
Toenails are thick or yellowed
Nails curve and grow into the skin
What should you NOT do when it comes to corn and calluses?
Do NOT:
- cut them
- use razor blades
-use corn/callus plaster or remover
What should be considered when using a pumice stone?
Okay to use if pt has intact sensation
First soak to soften skin
Use pumice stone in one direction
Who do we refer pts to?
Pedorthist/orthotist
- Shoes, orthotics
Podiatry/orthopedic surgeon
- Toenail problems, bone related problems
DOs of footwear
DO seek professional assistance in fitting shoes properly
DO buy shoes at the end of the day when your feet are the largest so that you can find the best fit
DO pinch up shoe at toe box to make sure toes have room (DEEP TOE BOX)
DO check to make sure ther
DON'Ts of footwear
NO vinyl or plastic shoes - can't breathe
NO pointed toes or high heels very
often because they put too much pressure on the toes
NO slip on shoes or loose fitting shoes (need securement ex: Velcro, Laces)
DON'Ts of footwear
NO vinyl or plastic shoes - can't breathe
NO pointed toes or high heels very often because they put too much pressure on the toes
NO slip on shoes or loose fitting shoes (need securement ex: Velcro, Laces)
What are the criteria for therapeutic footwear in the DM population?
1. History of partial or complete foot amputation
2. History of previous foot ulceration
3. Current foot ulceration
4. Foot deformity
5. History of pre-ulcerative callus formation
6. Documented neuropathy with
evidence of callus formation
7. Poor or impai
What are the criteria for therapeutic footwear in the DM population?
1. History of partial or complete foot amputation
2. History of previous foot ulceration
3. Current foot ulceration
4. Foot deformity
5. History of pre-ulcerative callus formation
6. Documented neuropathy with evidence of callus formation
7. Poor or impai
What type of CHRONIC foot problems should you notify your MD about at next appointment?
1. Sudden progression of foot deformity
2. Unilateral flattening of arch
3. Loss of sensation
4. Constant itchy feet - sign of fungal infection
What is LEAP?
Lower Extremity Amputation Prevention
A comprehensive program aimed at reducing lower extremity amputations in individuals with any condition that results in the loss of protective sensation in the feet
What are the 5 steps of LEAP?
1. Annual Foot Screening
2. Patient Education
3. Daily Self-Inspection
4. Footwear Selection
5. Management of Simple Foot Problems
What is the main goal of an Annual Foot Screening?
To identify those with loss of protective sensation by checking for poor circulation, nerve damage, skin changes, and deformities
What are the 2 screening tools used during an Annual Foot Screening?
Wagner Ulcer Classification System
The University of Texas Diabetic Wound Classification System
What is the Wagner Ulcer Classification System?
Identifies the grade of foot lesion based on the depth of penetration in a foot ulcer, the
presence of osteomyelitis or gangrene and the extent of the tissue necrosis
Grades ulcers on a scale of 0-5. 0 = no open lesions, 5 = extensive gangrene of the enti
What is the Wagner Ulcer Classification System?
Identifies the grade of foot lesion based on the depth of penetration in a foot ulcer, the presence of osteomyelitis or gangrene and the extent of the tissue
Grades ulcers on a scale of 0-5. 0 = no open lesions, 5 = extensive gangrene of the entire foot
L
What are the 2 special devices used during an Annual Foot Screening and why are they used?
A monofilament is used to determine if a patient can sense pressure in various areas of the foot
A tuning fork is used to determine if a patient can sense vibration in various areas, especially the foot and toe joints
The exam may reveal decreased or abse
Outside of the sensory exam, what other things will be competed during an Annual Foot Screening? EIERD
1. Examine nails for thickening, ingrown corners, length and signs of infection
2. Inspect socks or hose for blood or other discharge
3. Examine footwear for torn linings, foreign objects, breathable materials, abnormal wear patterns, and proper fit
4. Re
Need for Follow-up care based on Risk Levels 0-3
Risk 0: No loss of protective sensation
Risk 1: Loss of protective sensation in feet
Risk 2: Loss of protective sensation with callus/
deformity or poor circulation
Risk 3: History of ulcer or neuropathic fracture
Risk 0
1. Education emphasizing disease management
2. Education about proper shoe fit
3. Annual follow up for foot screen
4. Follow up as needed for skin, callus, nail care
*Brief education and AFS
Risk 1
1. Education emphasizing Disease management, Proper shoe fit, Daily foot inspection, Skin/nail care, Early reporting of foot injuries
2. Proper fitting/design foot wear with soft inserts/soles
3. Routine follow up every 3 to 6 months for foot exam and nai
Risk 2
1. Education emphasizing Disease control, Proper shoe fit, Daily foot inspection, Skin/nail care, Early reporting of foot injuries
2. Custom footwear, molded orthoses; modified shoes as needed; footwear with soft inserts/soles
3. Routine follow up every 1
Risk 3
1. Education emphasizing Disease control, Proper shoe fit, Daily foot inspection, Skin/nail care, Early reporting of foot injuries
2. Custom footwear, molded orthoses; modified/custom shoes as needed; ankle footwear orthoses as needed
3. Routine follow up
3 Micronutrients that may help with neuropathy
1. a-Lipoic acid
2. Vitamin B-12
3. Vitamin D
4 ways to promote peripheral circulation
1. Do not smoke
2. Exercise
3. Do not use heating pad/hot water bottle
4. Avoid plastic flip flops and narrow-toed
shoes
Important educational facts
HGbA1C < 7% to ? risk of microvascular complications
Loss of protective sensation?? risk of foot ulcer?? risk of amputation
Educational footwear facts
1. Do not walk barefoot even at home
2. At home wear slippers with rubber soles
3. Check shoes for objects before putting them on
4. Shoes should have closed toes/closed heels
5. Break-in new shoes gradually over several days
6. Replace shoes at least ann
DONTs of socks
NO nylon socks
NO elastic at top of socks
NO wrinkling of sock
NO heavy seams
NO colored socks
NO shoes without socks
Medical Conditions that are indicative of a refferal
1. Peripheral vascular
disease
2. End stage renal disease (on dialysis)
3. Tobacco Abuse
4. DM
- Poorly controlled diabetes (HgbA1C > 9%)
- Diabetic > 10 years
- Diabetic retinopathy
Medical Conditions that are indicative of a refferal
1. Peripheral vascular disease
2. End stage renal disease (on dialysis)
3. Tobacco Abuse
4. DM
- Poorly controlled diabetes (HgbA1C > 9%)
- Diabetic > 10 years
- Diabetic retinopathy
Who do we refer?
Pedorthist/orthotist
- Shoes, orthotics
Podiatry/orthopedic surgeon
- Toenail problems, bone related problems