The importance of prevention in podiatry in people with diabetes

The importance of prevention in podiatry in people with diabetes

The importance of prevention in podiatry in people with diabetes

Conceição Bacelar(1)

In diabetes and in the different forms of its complications, the prevention should always have a prominent place. Given the high prevalence of diabetes in our population (number of people with diabetes per 100,000 inhabitants) one would expect more knowledge in the general public and even in those affected, as most families will have a relative with diabetes.

One of the most feared and serious complications of this disease is the “diabetic foot” because it can lead to an amputation of a lower limb or part of it. Amputations are usually preceded by an ulcerative lesion that is often unnoticed by the patient. It is recognized that amputations can be reduced by 50 to 85% through preventive measures, education (information) of the patient and caregivers, timely treatment of ulcers and regular surveillance.

As a professional at CHUP-HSA where 35 years ago the 1st Multidisciplinary Diabetic Foot Consultation was born, I learned to value prevention and education/information in this area. To underline the importance of Prevention, I transcribe part of the preface to a small (small but very valuable) brochure for health professionals entitled “Practical Guidelines on the Treatment and Prevention of Diabetic Foot“. The preface, authored by Dr. Maria Beatriz Serra, founder of CMPD, begins with a story: A young worker, diabetic since the age of eight, put on his work boots again after his lunch break. They were heavy, thick, and with steel toes, as is used in civil construction. Putting them on was a routine in his day-to-day as a worker, but that day, the tip of the toecap of one was resting on a hot plate. The inside of the toecap was hot, but he didn’t feel it. Only at the end of the day he saw the sock wet by the blisters (bubbles) on his fingers that had burst. The next day and all the rest of the week, he continued to work. The pain of the developing infection never disturbed him. He suffered a transmetatarsal amputation (of the forefoot) and was out of work for many months. They had never explained to him that diabetes could numb his feet and the risk that meant for him.

This is a true story that took place many years ago. But many other similar ones have happened since then. Could they have been avoided? Actually yes.

A large number of people with diabetes lose sensory information from their feet and over time they no longer feel that the feet belong to them “…look, they see their feet, but they don’t feel their own any more than the shoes…” health (doctor, nurse, pharmacist, podiatrist, ) can prevent this loss in the mental body schema of diabetics with peripheral neuropathy if, early on in the disease and routinely, in the screening of possible complications, they monitor this dangerous focus. It is very important that during the consultation the subject is discussed, the patient is asked to remove shoes and socks to observe the foot well and investigate if there is already insensitivity or ischemia. And he takes advantage of it to “make education” *.

The complications of diabetes in the foot occur in the following areas: Nerve pathways, with a decrease or loss of sensation (as in the case described above). The patient does not feel that something hurts his feet. Arterial circulation, a decrease in blood supply to the foot may occur, making it difficult to heal a wound (arteriopathy) and Deformation of the foot, which can cause wounds as a result of friction with the footwear.

The symptoms of neuropathy can be manifested by a plantar pinprick sensation, walking on cotton wool, or numb feet. The symptoms of arteriopathy are pain in the calf of the leg when walking. Foot pain even at rest, which relieves when you get out of bed.

It is important to note that the absence of symptoms does not mean that the feet are healthy, as they may suffer from neuropathy, arteriopathy or even have an ulcer without any symptoms-

Hence the importance in Daily foot care :

Take a good look at your feet, including between toes, in a place with good light, with the help of a mirror or someone else. Wash daily with lukewarm water, do not soak feet. Dry well between fingers, by absorption and not friction, with soft fabric. Never place your feet in direct heat sources (hot water bags, heaters or fireplaces). To keep your feet warm, wear only soft cotton or wool socks. Even in summer, you should wear socks that should be light in color to facilitate visibility of any injury, they should not have strong elastic or protruding seams. In case the elastic is cut or loosened with the iron; if protruding seams, use the sock inside out. Apply moisturizer all over the foot (not between toes). File the nails weekly with a cardboard file; don’t wear too short or too tall. Avoid sharp objects (scissors, pliers, nail clippers). Do not use chemical products or dressings to remove calluses. You should look for a podiatrist with experience in diabetic foot or family nurse to treat, detect the cause and help resolve it properly.

In the face of an injury, always seek help from a professional and do not treat it yourself. 70% of injuries are caused by inappropriate footwear. Therefore, when choosing shoes, some aspects must be taken into account: the width of the shoe must be equal to the width of the foot; the height of the toe cap must be 3 mm higher than the highest toe; there must be a space of 1 cm in front of the foot after wearing it (No. above). Prefer velcro closure or cords to adjust to the foot and avoid friction in protruding areas. Wear leather shoes with rubber soles and reduced inner seams. Shoes should be bought at the end of the day, with the foot more dilated. New shoes should be worn gradually, with frequent inspection of the foot to ensure there are no areas of redness or blisters. When putting them on, always check the inside of the shoes to exclude that any object has inadvertently entered. And of course, always reinforce the reminder to No Smoking, Avoid Excess Weight, Keep Diabetes Controlled.

To finish a hopeful note: the feet are the support of our body, if we treat them well they are our friends.

*from the information leaflet,Jan.2021 CHUP ,Multidisciplinary Diabetic Foot Consultation

(1) CHUP-HSA Endocrinologist

Invited Professor ICBAS / 5th year MIM

CD ARSN Advisor / PND Regional Coordinator

#importance #prevention #podiatry #people #diabetes

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