Foot Care in Practice
Foot Care in Practice: Clinical recommendations for improving diabetic foot ulcer patient outcomes
Foot problems in diabetes are among the most serious complications of diabetes mellitus. Foot problems are a source of major suffering and costs for the patient, and they also place a considerable financial burden on healthcare and society in general. Foot care in practice needs a strategy that includes prevention, patient and staff education, multi-disciplinary treatment of foot ulcers, and close monitoring of people’s feet. Such practice may prevent diabetic foot ulcers and their sequelae like amputation or prolonged hospitalization.
Diabetic foot ulcers frequently result from a patient simultaneously having two or more risk factors, with diabetic peripheral neuropathy playing a central role. This neuropathy leads to an insensitive and sometimes deformed foot, often causing an abnormal walking pattern. In people with neuropathy, minor trauma (e.g., from ill- fitting shoes, walking barefoot or an acute injury) can precipitate ulceration of the foot. Loss of sensation, foot deformities, and limited joint mobility can result in abnormal biomechanical loading of the foot. This produces high pressure in some areas, to which the body responds with thickened skin (callus). This leads to a further increase of the abnormal loading, often with subcutaneous haemorrhage and eventually ulceration. Whatever the primary cause, if the patient continues walking on the insensitive foot it impairs wound healing.
There are five key elements that underpin prevention of foot problems:
1. Assess all people with diabetes and stratify their risk of developing foot complications
2. Regular inspection and examination of the at-risk foot
3. Education of patient, family and healthcare providers
4. Routine wearing of appropriate footwear
5. Treatment of pre-ulcerative signs
Diabetic Foot Ulcer Treatment
Foot ulcers will heal in the majority of patients if the clinician bases treatment on the principles outlined below. However, even optimum wound care cannot compensate for continuing trauma to the wound bed, or for inadequately treated ischemia or infection. Patients with an ulcer deeper than the subcutaneous tissues often require intensive treatment, and, depending on their social situation, local resources and infrastructure, they may need to be hospitalised.
There are seven key elements that underpin treatment of diabetic foot ulcers, whereby it is needed for these elements to be delivered by a multidisciplinary foot care team.
1. Relief of pressure and protection of the ulcer
2. Restoration of skin perfusion
3. Treatment of infection
4. Metabolic control and treatment of co-morbidity
5. Local wound care
6. Education for patient and relatives
7. Prevention of recurrence