NEW ORLEANS – Adults with diabetes can take an important step toward better overall health — and possibly prevent life-threatening complications — by simply taking off their socks and shoes and examining their feet twice a day.
Health care professionals also need to prioritize examining the feet of diabetic patients at every visit and stress the importance of checking the feet each day at home, Robert P. Thompson, CPed, executive director of the non-profit Institute for Preventive Foot Health, said during a session on diabetic foot health.
Robert P. Thompson
Awareness is key
According to a 2012 IPFH National Foot Health Assessment Survey, just 46.2% of patients with diabetes have regular foot screenings. Yet a small, untreated wound can quickly lead to a foot ulcer, infection and amputation, Thompson said, putting the patient at a higher risk for death.
“A diabetic foot is at risk 100% of the time,” Thompson said during the presentation. “Feet do tell a tale and everyone involved in treating a patient with diabetes — doctors, their staff, allied health care professionals and I’d like to include even retail or commercial footwear salespeople — should know the story and be able to interpret the signs.”
The five most common underlying causes behind foot problems are complex anatomy, natural biology, common foot conditions, disease and poor footwear, according to Thompson. No two feet are alike, Thompson said, and different approaches need to be taken depending on whether a heel is valgus or varus, if the forefoot pronates or supinates, or if the subtalar neutral strike of the heel to the ground is off. Fat pads on the bottom of the foot can also degrade with age and disease, putting a person at risk for further foot injury.
“These mechanical and biological characteristics may be in and of themselves problems for all of us, but the complications they may present to persons with diabetes can make them much more dramatic,” Thompson said. “Because their feet are so frequently insensate, the diabetic patient often never knows of the trauma his or her feet are experiencing until it’s too late.”
Importance of examination
To prevent dangerous foot problems, a person should have a physical foot assessment, measurement and fitting for proper shoes that suit the activities they partake in frequently. Proper socks — which Thompson described as “a medical accessory” — will better protect fat pads on the feet and wick away moisture from sweat.
“Socks are the soft-tissue management tools,” Thompson said. “Acrylic and acrylic-blend socks will minimize the impact pressure on your feet.”
Thompson also recommended either custom-designed orthotics or off-the-shelf commercial inserts as needed to promote proper foot and skeletal alignment, improve balance and stability.
“It’s not rocket science, it just takes watching the patients and improving on the kinetics of the body,” Thompson said.
Good foot hygiene is essential, Thompson said. Patients need to wash and thoroughly dry feet every day, using a mild soap and washing between the toes. Those with diabetes should wear protective footwear at all times, including at home, and keep shoes clean inside and out. Shoes should also be rotated whenever possible to allow any perspiration inside footwear to dry.
Health care professionals should advise their patients with diabetes to conduct visual inspections twice a day, Thompson said, paying attention to any pain felt and trying to discover the source. Those with insensate feet, he said, should be extra cautious.
“Impress upon them their need to seek medical attention for what might seem to them to be even the smallest of problems,” Thompson told Endocrine Today. “Swift, vigilant attention will save diabetic feet at risk.” – by Regina Schaffer
Thompson, Robert. W04. Presented at: The American Association of Diabetes Educators Annual Meeting 2015; August 5-8, 2015; New Orleans.
Disclosure: Thompson reports no relevant financial disclosures.