Foot Care in Diabetes Management

Diabetes is a metabolic disorder which occurs due to unbalanced insulin secretion by the pancreas. Diabetes can be categorised into two types: Type 1(when insulin secretion is less or almost none than the normal value) and Type 2(when insulin is secreted more than the required or normal range).

Foot ulcers are one of the most common indications of diabetes. Thus, foot care is one of the utmost and significant strategies in diabetes management.

Research has shown that Peripheral neuropathy and poor circulation in diabetes results in foot ulcers. Serious complications can result in gangrene and amputation of foot or leg. Thus doctors recommend gentle care of foot in both paediatric and elderly diabetic patients.

Patients with Diabetic foot ulcers can be classified into three categories, depending upon the level of risk: Low risk patients, Moderate risk patients and High risk patients.

Low risk patients have no past history of ulcer and have at least one pulse per foot. They have equal to or more than one of ten sites insensible to monofilament testing. Also, no foot distortion or physical or visual damage is observed.

In moderate-risk patients, both pulses in either foot can be lost. They have equal to or more than two sites insensible to monofilament testing. Foot distortion or wrap may be seen. Sometimes, patient is also unable to see or reach foot.

In high-risk patients, neuropathy is observed as pulses can be totally lost .Calluses formation leading to entire foot damage or amputation may be seen.

Foot Care Management in Diabetics in-turn depends upon: risk category, foot status and metabolic control.

For high-risk patients, visual foot inspection, by a physician or trained staff, to identify foot problems is recommended at every visit. Visual inspection involves examination of skin for wound, corns, sores, cracks, pustules or any unusual condition. Assessment of footwear for wavering lines, foreign substances, breathable materials, abnormal wearing patterns and improper fitting. For low-risk patients, visual inspection is advised atleast once in a year.

After the Visual Inspection, a Medical record is usually prepared by Physicians enclosing the details of physical assessment, including risk-assessment, results of visual inspection and guidance provided to patients for preventive care.

The Diabetes Quality Improvement Project (DQIP) is a joint initiative to improve diabetes care and the quality of life for diabetics. DQIP practices a set of eight Quality measures for diabetes, one of which stipulates that "an annual foot exam for adults with diabetes" should be documented and recorded. Several public organizations (the Department of Defense, the Health Care Financing Administration, the Indian Health Service, and the Veterans Health Administration) and private establishments (the American Diabetes Association Provider Recognition Program and the National Committee for Quality Assurance) are using some or all of the DQIP measures

Physician Guidelines as available for Management of Active ulcer or foot infection entails the following:

Not to allow patients with an open plantar ulcer walk out in their own shoes, weight relief should be provided

Prescription/Advising therapeutic footwear as per the patient condition

Frequent assessments

Patient education

Providing referrals of Specialists if required.

Attachment of labels and stickers specifying risk-level on OPD cards.

Patient Education entails the following instructions:

Daily wash of feet using mild soap and warm water

Drying of feet after wash-no rubbing, only pat drying.

Everyday examination of feet-doing check for blisters, sores, redness, corns, warmness etc.

Proper Care of toenails

Precautions during exercise

Protection of feet via socks and shoes-as advised by physician.

Thus,a dedicated effort from both Doctors and Patients can help in preventing foot complications in Diabetes.