Canadian Diabetes Association Clinical Practice Guidelines Foot Care

Chapter 32 Keith Bowering, John E bil

Foot Care Checklist

2013

EDUCATE about proper 0oot care EXAMINE 0or structural, 1ascular, neuropath. proble s DO a #& gra ono0ila ent assess ent

IDENTIFY those at high ris2 o0 0oot ulcers and educate, assess ore 0re3uentl., consider 0ootwear REFER ulcers to 0oot care ultidisciplinar. tea speciali4ed in

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Patie ts !ith DM are 20X More "ikel# to $e %os&itali'e( )or No *tra+,atic "i,$ A,&+tatio

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Pre-e tio thro+.h e(+catio Pro&er risk assess,e t Earl# a ( a..ressi-e treat,e t

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E(+cate Patie ts o Pro&er Foot Care / The 0DO1s2

DO 3 Chec2 .our 0eet e-er# (a# 0or cuts, crac2s, bruises, blisters, sores, in0ections, unusual ar2ings 5se a ,irror to see the botto o0 .our 0eet i0 .ou can not li0t the up Chec2 the colo+r o0 .our legs 6 0eet 7 see2 help i0 there is swelling, war th or redness 4ash a ( (r# #o+r )eet e-er# (a#, especiall. between the toes Appl. a good ski lotio e-er# (a# on .our heels and soles! 8ipe o00 e9cess Cha .e #o+r socks e-er# (a# (ri .our ails strai.ht across Clean a cut or scratch with ,il( soa& a ( !ater and co-er with dr. dressing guidelines!diabetes!ca " #$%&&$BA'()'G *22+$%,+," diabetes!ca 8ear good supporti1e shoes or pro0essionall. 0itted shoes with
Cop.right / 2&#3 Canadian Diabetes Association

E(+cate Patie ts o Pro&er Foot Care / The 0DON1Ts2

DO NOT 3 Cut .our own cor s or callo+ses (reat .our own i *.ro!i . toe ails or sli-ers with a ra'or or scissors! ;ee .our doctor or 0oot care specialist 5se o1er$the$counter edications to treat corns and warts A&&l# heat with a hot water bottle or electric blan2et 7 a. cause burns un2nowingl. 5oak .our 0eet (a2e 1er. hot $aths 5se lotio $et!ee #o+r toes 8al2 $are)oot inside or outside 8ear ti.ht socks6 .arter or elastics or k ee hi.hs 8ear o1er$the$counter insoles 7 a. cause blisters i0 not right 0or .our 0eet guidelines!diabetes!ca " #$%&&$BA'()'G *22+$%,+,- " diabetes!ca Cop.right 2&#3 Canadian Diabetes Association ;it 0or / long periods o0 ti e

%o! to Per)or, Pro&er Foot E7a,i atio

;tructural Abnor alities ;2in changes E1idence o0 in0ection Callous or ulcer <ange o0 otion Charcot 0oot (e perature ;2in changes An2le Brachial )nde9 #& gra ono0ila ent

Peripheral Arterial Assess ent 'europath. Assess ent

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Ra&i( 5cree i . )or Dia$etic Ne+ro&ath# Usi . 10 .ra, 5e,,es*4ei stei Mo o)ila,e t

=oss o0 sensation o1er the distal plantar sur0ace to the #&g ono0ila ent is a signi0icant and independent predictor o0 0oot guidelines!diabetes!ca " #$%&&$BA'()'G *22+$%,+,- " diabetes!ca ulceration and lower$e9tre it. a putation! Cop.right / 2&#3 Canadian Diabetes Association

4ho is at %i.h Risk o) De-elo&i . a Foot Ulcer8

>

Peripheral neuropath.
7

Mo o)ila,e t se satio loss obilit.

> > > > > >

Pre1ious ulceration or a putation ;tructural de0or it. or li ited ?oint Peripheral arterial disease @icro1ascular co plications Ele1ated A#C An.cho .cosis

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4he 5ho+l( a Foot E7a, $e Per)or,e(8

=ow <is2 Annuall.

Bigh ris2 0or ulcer

@ore 0re3uent E.g. E1er. 3$+

onths

Foot ulcer present

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<e0er to ultidisciplinar. tea with e9pertise in 0oot ulcers

%i.h Risk )or Ulcer9 Pre-e tio a ( Earl# Treat,e t

Bigh ris2 0or ulcer Foot care education Pro0essionall.$0itted 0ootwear

)0 ulcer de1elops

Pro pt re0erral to ultidisciplinar. tea with e9pertise in 0oot ulcers

guidelines!diabetes!ca " #$%&&$BA'()'G *22+$%,+,- " diabetes!ca Cop.right / 2&#3 Canadian Diabetes Association

Foot Ulcer9 M+lti(isci&li ar# Tea, A&&roach

8ound care =ocal 0actors Pressure o00loading Debride ent *nonische ic woundsGl.ce ic control ;.ste ic 0actors (reat in0ection Address lower$e9tre it. 1ascular status

guidelines!diabetes!ca " #$%&&$BA'()'G *22+$%,+,- " diabetes!ca Cop.right / 2&#3 Canadian Diabetes Association

Reco,,e (atio 1
#! )n people with diabetes, )oot e7a,i atio s b. healthcare pro1iders should be an i te.ral co,&o e t o0 diabetes anage ent to identi0. persons at ris2 0or ulceration and lower$e9tre it. a putation CGrade C, =e1el 3D and should be per0or ed at least a +all# and at ,ore )re:+e t inter1als in those at hi.h risk CGrade D, =e1el ,D

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Reco,,e (atio 1 ;co ti +e(<

#! Assess ent b. healthcare pro1iders should include the assess ent o0 ski changes, str+ct+ral abnor alities *e!g!, range o0 otion o0 an2les and toe ?oints, callus pattern, bon. de0or ities-, s2in te,&erat+re, e1aluation 0or e+ro&ath# and &eri&heral arterial (isease, +lceratio s and e1idence o0 i )ectio CGrade D, =e1el ,D

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Reco,,e (atio 2
2! People at hi.h risk o0 0oot ulceration and a putation should recei1e 0oot care e(+catio *including counseling to a1oid 0oot trau a-, &ro)essio all#*)itte( )oot!ear, and earl. re0errals to a healthcare pro0essional trained in 0oot care anage ent i0 0oot co plications occur
CGrade B, =e1el 2D

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Reco,,e (atio 3
3! )ndi1iduals who de1elop a )oot +lcer should be anaged b. a ,+lti(isci&li ar# healthcare tea with e9pertise in the anage ent o0 0oot ulcers to pre1ent recurrent 0oot ulcers and a putation CGrade
C, =e1el 3D

guidelines!diabetes!ca " #$%&&$BA'()'G *22+$%,+,- " diabetes!ca Cop.right / 2&#3 Canadian Diabetes Association

Reco,,e (atio =

2013

,! (here is currentl. i s+))icie t e-i(e ce to reco end an. s&eci)ic (ressi . t#&e 0or diabetic 0oot ulcers CGrade C, =e1el 3D! General &ri ci&les o) !o+ ( ,a a.e,e t in1ol1e the pro1ision o0 a ,oist !o+ ( e -iro ,e t, (e$ri(e,e t o0 non1iable tissue *nonische ic wounds- and o))loa(i . o0 pressure areas CGrade B,
=e1el 3D

guidelines!diabetes!ca " #$%&&$BA'()'G *22+$%,+,- " diabetes!ca Cop.right / 2&#3 Canadian Diabetes Association

Reco,,e (atio >

2013

>? E-i(e ce is c+rre tl# lacki . to s+&&ort the routine use o0 a(@+ cti-e !o+ (* heali . thera&ies such as topical growth 0actors, granuloc.te$colon. sti ulating 0actors, der al substitutes, or BBA( in diabetic 0oot ulcers but the. a. be considered in nonhealing, nonische ic wounds when all other options ha1e been e9hausted CGrade D, =e1el ,D

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CDA Cli ical Practice A+i(eli es

www!guidelines!diabetes!ca 7 0or pro0essionals #$%&&$BA'()'G *22+$%,+,www!diabetes!ca 7 0or patients

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