Nonprescription Products for Proper Diabetic Foot Care

An estimated 1 in 4 patients with diabetes develops foot complications at some point.¹ Research has shown that patients with diabetes are more susceptible to foot problems, principally because of neuropathy and peripheral vascular disease (PVD).^2,3 Neuropathy causes loss of feeling in the feet, resulting in the inability to experience discomfort and pain, which means that the patient might not detect an injury or irritation.^2-4 Poor circulation due to PVD diminishes the ability to heal, which can increase infection rates.^2-4 Patients with diabetes, particularly those with poorly controlled diabetes, are more susceptible to foot-related complications (Table 1).^{2, 5-7}

Lack of proper diabetic foot care can lead to infections, foot ulcers, and amputation. It is estimated that about 85% of amputations are preventable when patients receive ongoing education about daily foot care and early intervention.³ Fortunately, many diabetes-related foot complications can be corrected or prevented if detected early and treated properly. The chief goal of diabetic foot care is deterrence of complications. Preventive approaches include patient education, involvement, and compliance; emphasizing the importance of daily foot, nail, and skin care inspections and stressing the importance of maintaining tight glycemic control. ^3-5

As one of the most accessible health care providers, pharmacists are in a pivotal position to educate patients with diabetes, especially those with a new diagnosis, about the serious nature of routine diabetic foot care to delay or prevent complications.

Importance of Diabetic Foot Care

All patients with diabetes should receive an annual comprehensive foot exam, according to the 2018 American Diabetes Association’s (ADA) Standards of Medical Care in Diabetes-2018.⁸ Other recommendations for health care providers related to diabetic foot care include⁸:

• Inspect patients’ feet at every visit.
• Look for foot deformities, inspect the skin, and perform neurological and vascular assessment, including pulses in the legs and feet, at each exam.
• Offer general preventive foot self-care education to patients.
• Provide an annual comprehensive foot examination to identify risk factors predictive of amputations and ulcers.
• Refer patients who smoke and/or have structural abnormalities or have a history of prior lower-extremity complications to foot care specialists for continuing preventive care and lifelong surveillance, when warranted.
• Use a multidisciplinary approach for patients with foot ulcers and high-risk feet, particularly those with a history of prior amputation or ulcers.

For detailed information on the 2018 ADA Standards of Care in Medical Care in Diabetes, visit care.diabetesjournals.org/content/41/Supplement_1/S105.

Nonprescription Products

There are several nonprescription topical dermatological products marketed for routine diabetic foot care, and they include cleansers, creams, and lotions (Table 2).

Prior to recommending any nonprescription products for daily foot care, pharmacists should ascertain if patients are experiencing any issues that should be examined by a primary care provider to avoid further complications. When counseling patients about diabetic foot care products, pharmacists can also take the opportunity to emphasize the significance of adhering to therapy and sustaining tight glycemic control, the critical nature of daily foot care and skin inspections, and maintaining routine visits with primary health care providers. They can also provide patients with information about recommended routine diabetic foot care protocols and patient education resources (Tables 3^5-7,9-10 and 4).

Yvette C. Terrie, BSPharm, RPh, is a consulting pharmacist and a medical writer in Haymarket, Virginia.

References

• 4 tips for foot care when you have diabetes. Joslin Diabetes Center website. joslin.org/info/4_tips_for_foot_care_when_you_have_diabetes.html. Accessed August 20, 2018.
• Diabetes: foot & skin related complications. Cleveland Clinic website. my.clevelandclinic.org/health/diseases/9492-diabetes-foot--skin-related-complications. Updated April 5, 2015. Accessed August 20, 2018.
• Diabetes and foot amputation. American College of Foot and Ankle Surgeons website. acfas.org/backgrounders/amputation/. Accessed August 20, 2018.
• Diabetes complications and amputation prevention. American College of Foot and Ankle Surgeons website. foothealthfacts.org/conditions/diabetic-complications-and-amputation-prevention. Accessed August 20, 2018.
• Footwear matters. American Podiatric Medical Association website. apma.org/files/drcomfortfootwearmattersinfographic.pdf. Accessed August 20, 2018.
• Foot complications. ADA website. diabetes.org/living-with-diabetes/complications/foot-complications/. Accessed August 20, 2018.
• 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. Published January 2017. Accessed August 20, 2018.
• American Diabetes Association. Microvascular complications and foot care: standards of medical care in diabetes-2018. Diabetes Care. 2018;41(suppl 1): S105-S118. doi: 10.2337/dc18-S010.
• Diabetes and your feet. CDC website. cdc.gov/features/diabetesfoothealth/. Updated November 27, 2017. Accessed August 20, 2018.
• Coffey C, Srivastava S. Minor Foot Disorders. Minor foot disorders. In: Krinsky D, Ferreri S, et al, eds. Handbook of Nonprescription Drugs. 19th ed. Washington, DC: American Pharmacists Association; 2018.