Diabetic Foot Care

Daily foot care is essential to the self-management of diabetes, and pharmacists can recommend OTC products and techniques to prevent and treat infections.

According to the American Diabetes Association (ADA), foot ulcers and amputations are major causes of morbidity and disability for patients with diabetes, and they have high emotional and physical costs.¹ Patient education, early recognition, and the management of independent risk factors for ulcers and amputations can prevent or delay the onset of adverse outcomes.¹

The major goal of current diabetic foot care is prevention. Preventive strategies include a collaboration of patient education; prophylactic skin, foot, and nail care; and stressing the importance of protective footwear. ²

Pharmacists can have a significant impact on increasing awareness and educating patients with diabetes on the importance of routine foot care and screenings. These can prevent complications such as foot ulcers, which if left untreated can ultimately lead to amputation. When counseling patients with diabetes, pharmacists should seize the opportunity to remind them about the value of receiving an annual foot exam and establishing a daily foot care routine, which should include cleaning and inspecting for injuries, cuts, scrapes, or skin changes. Patients should also be reminded to seek medical attention for any foot problems. According to the 2010 ADA Standards of Medical Care, all patients with diabetes should receive an annual comprehensive foot exam.

There are a host of OTC dermatological products formulated for foot care to meet the specific needs of patients with diabetes. These include antimicrobial lotions, skin moisturizers, antifungal and callus treatments, powders, and alcoholfree foot sanitizers.

While assisting patients in the selection of foot care products, pharmacists can provide patients with diabetes with key information regarding foot care^3-6:

1. Inspect feet daily, including the tops, sides, heels, and between the toes.

2. When inspecting, look for cuts, cracks, splinters, blisters, and calluses on the feet. Always contact your primary health care provider if wounds show no signs of healing.

3. Wash feet in warm (not hot) water daily to prevent infections. Make sure the feet are thoroughly dried, especially between the toes.

4. When trimming toenails, cut them straight across, and round the edges slightly with an emery board.

5. To prevent drying and cracking of the skin, use lotion on the tops and bottoms of the feet but not between the toes.

6. Wear cotton, synthetic blend, or wool socks that are soft and dry to absorb moisture.

7. Wear supportive, enclosed shoes that fit well and protect your feet. Choose shoes that are made of leather, canvas, or suede, and are easily adjustable. Do not wear shoes made of plastic or another material that does not breathe.

8. To promote good circulation to the lower limbs when seated, prop your feet up and avoid standing in one position for long periods of time.

9. Adhere to your prescribed medication schedule and monitor blood glucose routinely to ensure glycemic control.

10. Do not attempt to remove corns or calluses without seeking the advice of your primary health care provider.

11. Do not use antiseptic solutions on your feet, because these may burn or injure skin.

12. To prevent foot injuries, do not walk barefoot, especially outdoors.

13. Immediately report any sores or skin changes, such as blisters, cuts, or soreness, to your primary health care provider.

14. Quit smoking, because it accelerates damage to blood vessels, especially the small blood vessels. This can lead to poor circulation, which is a major risk factor for foot infections and, ultimately, amputations.

As one of the most accessible health care professionals, the pharmacist can improve the quality of life of patients with diabetes by counseling them on foot care.

In addition to the guidelines above, pharmacists can use an excellent patient education resource on diabetic foot care entitled Take Care of Your Feet for a Lifetime, available on the National Diabetes Education Program Web site at: http://ndep.nih.gov/media/Feet_broch_ Eng.pdf.

For more information regarding diabetic foot care, please visit the following Web sites:

1. American Diabetes Association Web site: Foot Care

www.diabetes.org/living-with-diabetes/complications/foot-care.html

2. National Diabetes Education Program Foot Care Kit for Diabetes: Help Prevent Amputations

http://ndep.nih.gov/materials/pubs/feet/feet.htm

3. NIDDK: Diabetic Neuropathy: The Nerve Damage of Diabetes

www.niddk.nih.gov/health/diabetes/pubs/neuro/neuro.htm

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

References

1. Preventative foot care.Diabetes Care, Volume 27, Supplement 1, January 2004. Available at:

http://care.diabetesjournals.org/content/27/suppl_1/s63.full.pdf.

2. Pinzur M. Diabetic foot. eMedicine Web site. Available at: http://emedicine.medscape.com/article/1234396-overview.

3. Diabetes foot care. Medline Plus Web site. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/003937.htm.

4. Diabetes related amputations on the rise; daily foot care can help reverse trend. National Institute of Diabetes and

Digestive and Kidney Disease Web site. Available at: www2.niddk.nih.gov/News/SearchNews/11_01_2000.htm.

5. Foot care. American Diabetes Association Web site. Available at: www.diabetes.org/living-with-diabetes

/complications/foot-care.html.

6. Singh N, Armstrong DG, Lipsky BA. Preventing Foot Ulcers in Patients with Diabetes. JAMA. 2005:293:217-228.