Diabetic Foot Care

Introduction

Diabetes can be dangerous to the patient feet—even a small cut could have serious
consequences.Diabetes may cause nerve damage that takes away the feeling in patient feet.
Diabetes may also reduce blood flow to the feet, making it harder to heal an injury or resist
infection. Because of these problems, the patient might not notice a pebble in his/her shoe—
so thepatient could develop a blister, then a sore, then a stubborn infection that might cause
amputation of his/her foot or leg.

Purpose

• To maintain mobility and function in the well diabetic patient.

• For hygienic purpose.
• To promote circulation.
• To treat disease and detect problem of the feet.
 

Diabetes-related Foot and Leg Problem:

• Infections and ulcers (sores) thatdon’t heal. .

• Corns and calluses.  .

• Dry skin.  

• Hammertoes and bunions.  

• Charcot foot.

Assessment of diabetic foot:

1- Examine both feet and assess for:

a- Neurological status includes:Assess using the Semmes-Weinstein monofilament, pin and

vibratory sensation.  

**Mark the four or five, circled areas of the foot. Use a plus sign

(+) if they can feel the monofilament and a minus sign

(–) if they cannot.

b. Circulatory status includes: color, temperature, edema, capillary refill, and dorsalispedis
pulse (palpation or Doppler, if available).

c. Skin assessment includes: calluses, corns, fissures, lesions, and wounds.

d. Footwear is evaluated for condition, fit, stability, and protection

2. Assess skin surfaces for cleanliness, odor, dryness, and intactness.

3. Assess self-care abilities (e.g., any problems managing foot care).
4. Assess the patient for degeneration of peripheral nerves with loss of sensation.
 

Purpose

• To maintain mobility and function in the well elderly.

• For hygienic purpose.
• To promote circulation.
• To treat disease or problem of the feet.
Equipment

• BasinTowels
• Washcloth. Gloves.
• Lotion.    Nail clipper.
• Emery board.Orange stick.              Mirror.
• Waterproof pads (2).Soap or other cleansing agent.
Intervention

Nursing Interventions

Rationale

Assess the general appearance of the foot.

Foot lesions and associated wound infections are teh most common reason for hospitalization
of the patient with DM. The patient’s feet should be meticulously inspected at every visit. The
patient may be unaware of injuries to the feet as a result of decreased sensation from
peripheral neuropathy. Impaired vision from DM may decrease the ability to inspect the feet.

Assess the status of the nails.

Fungal infections in nails serve as a portal of entry for bacteria. The patient with diabetes has
an increased risk for infection because of impaired immunity. Patients with thickened or
deformed nails should be referred for treatment.

Assess the patient’s skin integrity.

Autonomic neuropathy leads to decreased perspiration, causing excessive dryness and

fissuring of the skin. Skin breakdown predisposes the patient to infection.

Note the presence of callus formation or corns.

Pressure over bony prominences lead to callus formation; may lead to the development of
skin breakdown.

Assess for evidence of infection.

Infection may be the initiating even for eventual amputation. Symptoms of pain and
tenderness may be absent because of neuropathy. Look for redness, drainage, and swelling.

Assess for edema.

Edema is a major predisposing factor to ulceration. Autonomic neuropathy results in the loss
of vasomotor reflexes and swelling in the foot.

Instruct the patient in the principle of hygiene: wash the feet daily in warm water using mild
soap; avoid soaking the feet. Dry carefully and gently, especially between toes. Use
moisturizing lotion at least once daily. Avoid the area between the toes.

Maceration between the toes predisposes the patient to infection. The use of lotion replaces
the moisturizing effects lost by autonomic neuropathy. The patient should select a lotion with
low alcohol content to prevent drying.

Instruct the patient to inspect the feet daily for cuts, scratches, and blisters. A mirror may be
necessary to assess the bottom of the foot. Instruct to use both visual inspection and touch.

All surfaces of the foot need to be examined, including the skin between toes. Touch will
identify skin surface alterations that are not evident by sight.

Teach the patient to inspect the shoes daily by feeling the inside of the shoe for irregularities
or sharp objects.

Reduces the risk for injury to the foot.

Instruct the patient to always wear protective footwear; never go barefoot.

Keeping the feet covered prevent injuries to the foot.

Instruct the patient to trim nails straight across and to file sharp corners to match the contour
of the toe.

Helps avoid injury to the toes when self-care cannot be provided.

Instruct the patient to wear clean, well-fitting stockings made from soft cotton, synthetic
blend, or wool.

Soft cotton or wool absorbs moisture from perspiration and discourages an enviroment in
which fungus can thrive.