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Feet: Skin & Wound Care Cheat Sheet by

care     healthcare     decubitus     ulcers     skin     wounds

Introd­uction

Diabetic neurop­athic wounds are caused by pressure and/or trauma, secondary to peripheral neuropathy and/or arterial insuff­iciency and poor microv­ascular circul­ation, inadequate blood sugar control and lack of sensation. Foot ulcera­tions are extremely common in the neurop­athic patient.

These ulcers often lead to compli­cations that can result in amputa­tion. In fact, about every 30 seconds, a person loses a limb as a result of diabetes in this country alone. Therefore, it is imperative to prevent these wounds before they become a problem. The following measures can decrease the potential for developing a diabetic neurop­athic wound.

Pevention

Perform daily foot care that includes inspecting the feet, washing with a pH-bal­anced cleanser (not soap) and drying well between the toes.
Prevent xerosis, dry scaling or fissuring skin of the feet by applying a good quality advanced moistu­rizing and nutrit­ional cream after drying the feet. Do not apply it between the toes, due to increaseg likelihood of fugal manife­sta­tion.
Avoid soaking the feet. This is never recomm­ended, even for those who do not have diabetes.
Wear clean socks that wick moisture away from the skin
Wear clean socks with no seams or mended areas to avoid irritation or cause pressure.
Avoid wearing shoes without stockings or socks, and do not wear sandals with thongs between the toes, or flip flops.
Visit a health care profes­sional for foot care of toenails, corns and calluses.
Reduce pressure on bony promin­ences, especially on the foot.
Avoid over-t­he-­counter medica­tions for corns and calluses, antiseptic solutions and adhesive tape.
Avoid crossing the legs.
Avoid cold and hot temper­ature extremes.
Avoid external heat sources, including heating pads, hot water bottles, hydrot­herapy and other hot surfaces.
Follow-up with a health care provider on a routine basis.
Avoid smoking.
Keep diabetes under control.
Notify the provider immedi­ately if a sore, blister, cut or scratch develops.
Consider referral to an approp­riate dietician or nutrit­ionist.
Be aware of poor eyesight and its affect on the overall self care of the resident.
 

Shoes for Wound Prevention

Shoe design recomm­end­ations

Allow for .5 inches of space beyond the longest toe.
Allow adequate width and depth for toe spread and at the ball of the foot.
Check for adequate heel-t­o-ball fit.
Shoes should match the shape of the foot.

Shoe fitting recomm­end­ations

Approp­riate commer­cially available shoes should be made of a natural material, such as leather. They should have cushioned outer
soles, removable inner liners and secure with laces or hook-a­nd-loop fasteners. Be sure to inspect the inside of shoes every day
for foreign objects, nail points, torn linings and rough areas.

Shoes should be fitted in the afternoon wwhen edema tends to peak.
Have the patient stand and walk when being fitted for shoes.
Socks or stockings that will be worn regularly should be used when fitting new shoes.
Both feet should be measured and shoes fitted to the larger foot.
Wearing of new shoes should be increased gradually one to two hours at a time
Routine foot inspection to check for areas of pressure following each wearing session.

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