The SCRIPT for Diabetic Foot Care

Dr. Russell is a pharmacist with CVS/ Caremark in Phoenix, Arizona. Dr. Throm is an assistant professor at Midwestern University College of Pharmacy—Glendale, Glendale, Arizona.

In 2004, 18.2 million individuals had diabetes mellitus; 1 of every 6 diabetics will develop a diabetic foot infection in their lifetime.¹ Patients with diabetes have a 30-fold higher lifetime risk of undergoing lower-limb amputations, and diabetic foot infections account for the largest number of diabetes-related hospital bed days.^2,3 With diabetic foot ulcers being the most common cause of lower-limb amputation, it is essential that the health care team make every effort to educate the patient on the prevention of foot ulcers.⁴

What Can Pharmacists Do to Help Reduce Foot Ulcers?

The key to reducing the occurrence of foot ulcers is education. Patient education and guidance are keys to help the patient understand the importance of proper foot care. The pharmacist is readily available to provide health care– related advice and often sees patients who do not regularly see their primary care physician. By taking a few minutes to focus on patient education, the pharmacist can make a difference in the prevention of diabetic foot ulcers.

Who Is at Risk?

Patients with diabetes who are at highest risk for developing a foot ulcer and who can benefit by preventive education include⁵:

• Patients who have uncontrolled diabetes as evidenced by high hemoglobin A1C, lack of adherence to diet or medication regimens, or consistently high blood glucose readings
• Patients who have a history of diabetic foot ulcers or infections
• Patients who have poor hygiene or who appear not to have the proper footwear
• Patients who have abnormal foot shape or uneven gait when walking

Helpful Counseling Points

• Remind patients to inspect feet daily and monitor for changes in skin integrity, swelling, or formation of any new calluses or ulcers.
• Proper footwear is essential to help prevent pressure ulcers. Most insurance plans cover diabetic footwear if a podiatrist deems it necessary. Refer patients to a podiatrist for annual evaluations and further guidance in choosing the correct shoes.
• Patients should never walk barefoot. Even at home, the patient is at risk of injuring the foot unknowingly due to decreased sensation in the feet.
• Stress the importance of keeping the feet clean and dry. The feet should not be in a moist environment, as this may increase skin breakdown.
• Conversely, the skin on the feet should not be so dry that the skin is prone to cracking. Most patients with diabetes will need to apply a moisturizing ointment daily to help prevent cracking of the skin.
• Instruct patients to never attempt to remove a callus or ulcer on their own, as this may lead to increased risk of infection.
• Refer patients to a podiatrist to be instructed on the proper way in which to trim the toenails to avoid trimming them too low and increasing risk of infection.
• If a wound is discovered on the foot, refer the patient to a physician immediately. The longer an ulcer is present without treatment, the poorer the prognosis.

Through vigilance and effort, pharmacists can be a vital part of the health care team and help prevent foot ulcers and infections. The proactive pharmacist can help identify patients who are at risk for developing foot ulcers and provide these patients with the information they need to become active participants in their own health care and in the prevention of diabetic foot ulcers.

References

• Lipsky BA, Berendt AR, Deery HG, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2004;39:885-910.
• Lavery LA, Armstrong DG, Wunderlich RP, Mohler MJ, Wendel CS, Lipsky BA. Risk factors for foot infections in individuals with diabetes. Diabetes Care. 2006;29:1288-1292.
• Frykberg RG. Diabetic foot ulcers: pathogenesis and management. Am Fam Physician. 2002;66:1655-62.
• Wagner FW Jr. The diabetic foot. Orthopedics. 1987;10:163-172.
• Boyko EJ, Ahroni JH, Cohen V, Nelson KM, Heagerty PJ. Prediction of diabetic foot ulcer occurrence using commonly available clinical information. Diabetes Care. 2006;29:1202-1207.