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Practical Guidelines
PRACTICAL GUIDELINES
* On the management and prevention of the diabetic foot
* These are taken with permission
from 'International Consensus on the diabetic foot' - prepared by International
working group on the diabetic foot, based at Netherlands.
Five cornerstones to
the management of the diabetic foot
| Regular Inspection and examination
of the foot at risk |
1
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| Identification of the foot
at risk |
2
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| Education of patient, family
and healthcare providers |
3
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4
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| Treatment of non-ulcerative
pathology |
5
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Sensory loss due to
diabetic polyneuropathy can be assessed using the following techniques:
| Pressure perception |
Semmes-Weinstein monofilaments (10
gram) The risk of future ulceration can be determined with a 10
gram monofilament |
| Vibration perception |
128 Hz tuning fork (hallux) |
| Discrimination |
Pin prick (dorsum of foot, without
penetrating the skin) |
| Tactile sensation |
Cotton wool (dorsum of foot) |
| Reflexes |
Achilles tendon reflexes |
Details to be covered
when instructing the high-risk patient
- Daily feet inspection, including areas between
the toes.
- If the patient cannot inspect the feet,
someone else should do it.
- Regular washing of feet with careful drying,
especially between the toes.
- Temperature of the water should always
be less than 37ºC.
- Avoidance of barefoot walking indoors or
outdoors and wearing of shoes without socks.
- Chemical agents or plasters should not
be used to remove corns and calluses.
- Daily inspection and examination of the
inside of the shoes.
- If vision is impaired, the patient should
not try to treat the feet (e.g. nails) by themselves.
- Lubricating oils or creams should be used
for dry skin, but not between the toes.
- Daily change of stockings.
- Wearing of stocking with seams inside out
or preferably without any seams at all.
- Cutting nails straight across. (see figure)
- Corns and calluses should not be cut by
patients, but by a health care provider.
- The patients must ensure that the feet
are examined regularly by health care provider
- The patient should notify the healthcare
provider at once if a blister, cut, scratch or sore has developed.
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The Internal width
of the shoe should be equal to the width of the foot.
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Fig-2
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Common causes of foot problems
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Wrong footwear (pic-1)
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Commonly used footwear in South
India- Hawai slippers (pic-2)
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Indigenous corn treatment
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Religious beliefs leading to barefoot
walking
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Summary
Signs of infection of a
Foot Ulcer
Infection in a diabetic foot presents threat
to the involved limb and should be treated promptly and aggressively.
Signs and/or symptoms of infection, such as fever, pain or increased
white blood count/ESR, are often absent. But, if present, substantial
tissue damage or even development of an abscess is likely.
The risk of osteomyelitis should be determined. If it is possible to
place a probe down to the bone before initial debridement, there is
an increased risk of the presence of osteomyelitis.
Gram-positive bacteria usually cause a superficial infection. In cases
of deep infections, Gram stains and cultures from the deepest tissue
involved are advised - (no superficial swabs); these infections are
usually polymicrobial, involving anaerobes and Gram positive/negative
bacteria.
The surgical decompression technique of our surgical colleague is an
original work which when applied correctly and early has helped prevent
amputations in over 90% of the cases of limb threatening diabetic foot
infections.
Potentially
Limb Threatening Situation
Foot Ulcer Treatment
Sensory Foot Examination
Foot Care Tips
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