During education on foot care I hear that providers are not completing this standard of care annually. As educators do we just question if it is practiced? I see the topic of foot care documented in follow up visits. Do we need to question about foot problems earlier?
In life we show affection when kissing those sweet baby feet. As we grow older and walk daily we begin to hide our feet if bunions, callous, foot and toe deformities appear. The ever present obesity epidemic is creating additional foot risks for young and old.
We can begin evaluating for foot risk when patients walk into our inpatient/outpatient settings. Yes, you can observe their gait, shoe wear, weight, and if deconditioned. We question if they smoke, have vision impairments, neuropathies, arthritis and myalgia. We hear about restless legs, paresthesia, burning sensation, edema, and claudication and rest pain in lower extremities. These issues impact the ability to walk correctly, changing foot shape and how we land on them.
Working as an APRN-BC, CDE alongside wound care nurses I have gained first-hand knowledge how the loss of ability to detect noxious, painful and thermal stimuli prevents detection of life threatening problems. Repetitive plantar mid-foot and hind foot pressure leads to tissue inflammation, ulceration and eventual necrosis. Statistics have shown Diabetes is the leading cause of non-traumatic amputations in the US. The highest incidence affects persons 45-64 years of age, more males than females. This impacts productivity and family income. Diabetic foot ulcers/ amputations will cause physical, emotional and financial suffering, impacting quality of life.
Our hospital sits one mile from the seashore, we are a resort town. Each summer we treat plantar foot wounds from walking on hot sand. The beach also has caused wounds from broken shells and debris at the shore line. We have implemented use of water shoes into our curriculum. Education is what we but do we teach affordable and
practical? Can we encourage looking at bottom of feet with dollar store mirrors while sitting on the commode or having a loved one look at them? Using Vaseline on thick dry skin and callous, instead of high cost lotions/creams. Purchasing dollar store washcloths to use to dry between toes when towels too thick. Slippers or crocks to wear indoors as accidents can occur from fallen earring stems, tacks or sewing needles. Shoe insoles should be assessed daily for tears and the shoe turned upside down before wearing to remove foreign bodies.
Blood glucose control must be achieved to enhance wound healing and reduce infection. Our CDE specialty will evaluate meter memories, computer printouts, and correct use of medications, food intake, stressors, barriers and risks.
Our ADA recognized programs require referrals to other professional when care needs are out of our scope of practice. There services may include: MNT for healthy eating, weight reduction and nutritional supplement information to enhance wound healing. Podiatry for foot deformities and toenail care. Podiatrists have access to specialty foot wear with higher toe boxes for toe deformities, larger width, depth and sole protection with Velcro or ties to keep the neuropathic foot in place. Medicare will cover specialty shoes with 3 inserts annually. Wound care centers with teach the importance of keeping wounds covered to prevent the pathogens in dark, damp shoes from infection. The appropriate wound products are chosen and evaluated frequently until healing occurs. A new treatment modality is hyperbaric oxygen chambers to increase O2 contact and provide closure when other options have failed. Physical Therapy can assist with deconditioning, balance and improve function. Vascular specialists will evaluate ABI in lower extremities and toes to evaluate benefit of angioplasty or bypass to enhance blood flow prior to surgical evaluation for amputation. The endocrinologists will assist us in appropriate medication choices to reduce A1C and glucose control.
Wow, as CDE’s there is so much we could offer to reduce foot injury. Yes, reinforce need to remove shoes and socks at next provider visit. Remember feet take us everywhere we need to go, it is important to keep them. I hope this review will assist you with foot care needs in your practice.
Christina Trout ACNS_BS, CDE
Beebe Healthcare
424 Savannah RD
Lewes, DE 19958
DE/PA AADE