Diabetic Foot Care: Taking the Right Steps

As the number of type 2 diabetes (T2D) cases continues to escalate each year, pharmacists are likely to encounter patients inquiring about proper diabetic foot care. Foot problems are very common in patients with T2D, accounting for a significant portion of diabetes- related complications and health care costs.¹ Pharmacists are in a pivotal position to educate patients with a new diagnosis of diabetes about their care.

Pharmacists should remind patients about the importance of routine diabetic foot care to prevent or delay complications, such as diabetic foot ulcers and amputations. Patients with diabetes, especially those with poorly controlled disease, are more susceptible to skin-related complications; therefore, patients should be reminded that many dermatologic conditions can be either prevented or effectively treated if identified early. Conducting a daily skin inspection and adhering to daily skin care, especially foot care, is imperative for all patients with diabetes. Pharmacists should seize every opportunity to stress the importance of maintaining tight glycemic control and remind patients how proper and routine foot care is critical to decreasing the incidence of foot ulcers and amputations. It is estimated that nearly 85% of amputations are preventable with education and early intervention.²

The primary goal of diabetic foot care is prevention of diabetes-related complications, such as changes in the skin (dryness and itching) and foot ulcers, which are often attributed to vascular disease, neuropathy, and relative immunosuppression.^3,4 Foot problems are more common among patients with diabetes compared with the general population (Table 1^3,4). Strategies for preventing foot problems include patient education, patient involvement and adherence, maintenance of tight glycemic control, and daily care and inspections of the skin, feet, and nails.^2,5 According to the American Podiatric Medical Association, foot care programs have helped to decrease the incidence of foot ulcers and amputations from 85% to 45%. These programs include risk assessment, foot care education, preventive therapy, prompt treatment, and referrals to specialists, when warranted.

Table 2. Examples of Dermatologic Products for Patients with Diabetes

Product Name

Manufacturer

Anastasia Diapedic Foot & Leg Treatment

Anastasia Marie Laboratories

DiabetAid Pain and Tingling Relief Lotion

Prestige Brands

DiabetDerm Foot Rejuvenating Cream

DiabetDerm Heel and Toe Cream

DiabetDerm Antifungal Cream

Healthcare Products

Diabetic Basics Healthy Foot & Body Lotion

Woodward Labs

Diabet-X Callus Treatment

Diabet-X Antifungal Skin Treatment

Diabet-X Skin Therapy Lotion

Diabet-X Daily Prevention Skin Therapy

FNC Medical Corporation

Flexitol Diabetic Foot Balm

Labderma

Gold Bond Diabetics Dry Skin Relief Foot Cream

Chattem, Inc

Neoteric Oxygenated Advance Healing Cream

Neoteric Cosmetics, Inc

PediFix Diabetic Defense Daily Therapy Foot Wash

PediFix

ReliOn Callus Treatment

Wal-Mart Pharmacies

Zim’s Crack Creme, Diabetic Formula

Zim’s Wound Care Gel with Collagen and Silver

Perfecta Products, Inc

Zostrix Diabetic Foot Pain Cream

Healthcare Products

According to the American Diabetes Association’s Standards of Medical Care released in 2016 (care.diabetesjournals.org/content/39/ Supplement_1), all patients with diabetes should have an annual comprehensive foot exam.⁶ The standards includes the following⁶:

• Patients should get an annual comprehensive foot examination to identify risk factors for ulcers and amputations.
• Patients should receive general foot self-care education from their primary health care provider.
• A multidisciplinary approach is recommended for patients with foot ulcers and feet at high risk for them, especially individuals with a history of ulceration or amputation.
• When warranted, refer patients who smoke and/or have structural abnormalities or a history of lower-extremity complications to foot care specialists for ongoing preventive care and lifelong surveillance.

Several OTC dermatologic products are marketed specifically for foot care in patients with diabetes (Table 2). Prior to recommending any of these products, pharmacists should encourage patients with certain signs or symptoms to seek immediate medical care to avoid further complications (Table 3^4,7). Examples of diabetic foot care products include antimicrobial lotions, skin moisturizers, and antifungal and callus treatments.

When counseling patients with diabetes about dermatologic products, pharmacists can also take the opportunity to reinforce the importance of daily foot care and skin inspections, as well as provide key information on diabetic foot care protocols (Tables 4^3-8 and 5). To learn how to recognize and manage the numerous diabetes-related foot complications, patients should be encouraged to discuss them with their primary health care provider. Pharmacists can help empower patients with the knowledge they need for effectively controlling their diabetes. Tight glycemic control and routine foot care are key steps patients can take toward preventing or decreasing diabetes-related foot complications and enhancing their quality of life.

Ms. Terrie is a clinical pharmacist and medical writer based in Haymarket, Virginia.

References

• Driver VR, Fabbi M, Lavery LA, Gibbons G. The costs of diabetic foot: the economic case for the limb salvage team. J Vasc Surg. 2010;52(suppl 3):17S-22S. doi: 10.1016/j.jvs.2010.06.003.
• Diabetes and foot amputation. American College of Foot and Ankle Surgeons website. acfas.org/backgrounders/amputation/. Accessed August 20, 2016.
• Footwear matters. American Podiatric Medical Association website. apma.org/files/drcomfortfootwearmattersinfographic.pdf. Accessed August 20, 2016.
• Foot complications. American Diabetes Association website. diabetes.org/living-with-diabetes/complications/foot-complications. Accessed August 20, 2016.
• Diabetes and foot problems. National Institute of Diabetes and Digestive and Kidney Diseases website. niddk.nih.gov/health-information/diabetes/preventing-diabetes-problems/keep-feet-healthy. Accessed August 20, 2016.
• Standards of medical care in diabetes-2016: summary of revisions. Diabetes Care. 2016;39(suppl 1):S4-S5. doi: 10.2337/dc16-S003.
• Living with diabetes: keep your feet healthy. CDC website. cdc.gov/features/diabetesfoothealth/. Accessed August 20, 2016.
• Ulbrich T, Krinsky D. Self-care components of selected chronic disorders. In: Krinsky D, Berardi R, Ferreri S, et al, eds. Handbook of Nonprescription Drugs. 18th ed. Washington, DC: American Pharmacists Association; 2015.