Stepping Forward Diabetes and Foot Care Clinical Health Education

7/1/2014 Chronic Conditions Management Department

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What do you know about the relationship between diabetes and

your feet?

What steps are you taking to prevent foot related problems?

Foot Facts About Diabetes

25% of hospital admissions for people with diabetes are due to foot infections

There are more than 86,000 amputations per year due to diabetes 85% of amputations are preceded by a foot ulcer People with diabetes have a 15% lifetime risk of developing an ulcer After 1 major lower-extremity amputation

– 3-year survival rate is 50% – 5-year survival rate is 40%

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Neuropathy

Nerves are unable to transmit information to the brain. Affects ability to feel pain, temperature,

movement, and balance Involves eyesight, taste, hearing, bladder,

sexual organs, coordination, and digestion Symptoms include burning, tingling,

numbness, pain, odd sensations, loss of balance, and instability

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Vascular Disease

Inflammation, high blood sugar, high cholesterol, and high blood pressure lead to poor circulation, called vascular disease, in the legs, feet, and toes.

This lack of oxygenated blood flow impairs the body’s ability to fight infections and heal.

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Immunopathy High blood sugar greatly reduces ones ability to fight and heal infection Infection, a stress on the body, raises blood sugar High blood sugar impairs white blood cell function

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High Blood Sugar

Increased risk of

infection

How did this happen?

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Gangrene Pavement Burn

Vascular Disease

Ulcer

Importance of Prevention

Neuropathy, vascular disease and immunopathy can lead to the removal of a body part (amputation)

People afflicted with these conditions have a 40 times higher risk of amputation

Simple interventions, good diabetes control and proper foot care may decrease the amputation rate up to 85%

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Prevention is Key… Control Your Blood Sugar

Monitor How am I doing today? Meals Are my food choices making me healthier? Motion How can I stay active? Medication Am I taking medications as prescribed? Mood How is my mood effecting my diabetes? Motivation Where does motivation come from?

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Prevention is Key

Check Your Feet Foot Hygiene Shoes and Socks

Examine them everyday at home

Ask your medical provider for an exam

Report any changes

Keep them clean and dry

Care for your nails

Avoid calluses

Promote circulation

Protect your feet

No bare feet!

Buy appropriate shoes and socks

Ask about special shoes

Check Your Feet

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Look for: – Redness or swelling – Cuts or abrasions – Ingrown toenails – Blisters, corns or calluses – Dry, cracked or bleeding skin – Athlete’s foot, infected, thick or discolored nails – Ulcers

Take action:

– Give first aid (wash with soap, bandage if needed) – Call your medical provider within two days if no improvement (call

immediately for urgent concerns)

Ask your medical provider for a basic foot exam at EVERY visit and a detailed foot exam once a year

How do my feet look and feel today?

Foot Hygiene

Wash – Mild soap and warm water, pat dry instead of rubbing – Moisturize with fragrance-free and dye-free lotion – Dry toes completely, do not moisturize between toes – Do not cut, shave or use harsh chemicals

Nail Care

– Use your own clean tools – File nails straight across – Use tea tree oil to soften infected nails, if needed – Discuss new or existing conditions with your provider – See attached “fee for service” resource listing

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Nail Salons

Bring your own clean tools Ensure cleanliness and current licensure Do not use metal tools on skin (scissors or razors) Avoid nail salons if you have an existing foot related medical issue

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Foot Hygiene

Prevent Calluses – Moisturize (keratinolytic/ammonium lactate 12%) – Pumice stone or foot file (not metal) – Check with your doctor before using a pumice stone or foot file

Promote Circulation – Do not smoke, it decreases blood flow – Avoid crossing your legs – Stay active – Move your ankles and toes – Massage gently

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Foot Wear to Avoid

High heels place too much weight on the forefront and can cause calluses and blisters

Pointed shoes pinch toes and can reduce circulation and cause blisters

Flip flops and slip on shoes have little/no support or protection and increase risk the for falls

Worn out shoes do not provide support and may fit poorly causing blisters and calluses

Foot Wear

Old shoes –Trace each foot on paper –Place shoes over outline

New Shoes –Buy new shoes wearing your regular socks –Allow for 1/2 inch extra length in toe box –Supports and covers entire foot –Wide enough toe box –No seams inside –Short and sturdy heels –Do not allow toes or heel to rub –Break in new shoes slowly

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Ask for assistance when buying new shoes

Ask about coverage for special shoes Member services 1-800-464-4000

Always wear shoes!

Foot Wear

Socks –Breathable, moisture wicking socks –Snug but not tight –Seamless (avoid seams over toes) –Check for holes or anything stuck in sock –Change socks frequently

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Cotton Ball Test

Ask for assistance from a family member or friend

Remove shoes and socks and close your eyes Ask assistant to check for sensation:

– Lightly touch cotton ball on each area

– Say ‘yes’ when you feel sensation

– Notice whether or not you can feel each area

– Avoid callused areas

– Repeat on the other foot – Report any changes/concerns to your medical provider at your next visit

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SMART Plan Telephone Wellness Coaching 1-866-251-4514 Set a Behavioral Goal

– Observable, measurable, short-term, achievable, challenging

Monitor Your Progress – Tracking behavior changes behavior

Arrange Your World for Success (home or work place) – List 3 ways to make the healthy choice easier

Recruit Support – Ask for the support you need

Treat Yourself – Behavior that is rewarded is repeated

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Resources: Film and Books

Currently for sale in Kaiser Health Promotion Centers $20

Currently for sale in Kaiser Health Promotion Centers $15

Currently for sale in Kaiser Pharmacy Centers $6.95

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— Sidney Garfield, MD, founding physician Kaiser Permanente

“ Remember, good health is a way to get more out of life, more energy, more enjoyment, more potential, more purpose, more life.”