ch32_footcare

8/12/2019 Ch32_FootCare

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Canadian Diabetes Association

Clinical Practice Guidelines

Foot Care

Chapter 32

Keith Bowering, John Ebil


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guidelines!diabetes!ca " #$%&&$BA'()'G *22+$%+- "diabetes!ca

Cop.right / 2 Canadian Diabetes Association

EDUCATEabout proper 0oot care

EXAMINE 0or structural, 1ascular, neuropath.

probles

DO a #& gra ono0ilaent assessent

IDENTIFY those at high ris o0 0oot ulcers and

educate, assess ore 0reuentl., consider 0ootwear

REFER ulcers to ultidisciplinar. tea speciali4ed in

0oot care

2013Foot Care Checklist


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Cop.right / 2 Canadian Diabetes AssociationPublic Health Agency of Canada (August 2011); using 2008/09 data fro the Canadian Chronic !isease "ur#eillance "yste (Public Health Agency of Canada)$

Patiets !ith DM are 20X More "ikel# to $e

%os&itali'e( )or No*tra+,atic "i,$ A,&+tatio


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Pre-etio thro+.h e(+catio

Pro&er risk assess,et

Earl# a( a..ressi-e treat,et


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E(+cate Patiets o Pro&er Foot Care / The DOs

DO

Chec .our 0eet e-er# (a# 0or cuts, cracs, bruises, blisters,

sores, in0ections, unusual arings5se a ,irrorto see the botto o0 .our 0eet i0 .ou can not li0t theup

Chec the colo+ro0 .our legs 6 0eet 7 see help i0 there is

swelling, warth or redness4ash a( (r# #o+r )eet e-er# (a#, especiall. between the toes

Appl. a good ski lotio e-er# (a# on .our heels and soles!8ipe o00 e9cess

Cha.e #o+r socks e-er# (a#(ri .our ails strai.ht across

Clean a cut or scratch with ,il( soa& a( !ater and co-erwithdr. dressing

8ear good supporti1e shoes or pro0essionall. 0itted shoes with


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E(+cate Patiets o Pro&er Foot Care / The DONTs

DO NOT

Cut .our own cors orcallo+ses

(reat .our own i*.ro!i. toeails orsli-ers with a ra'or orscissors! ;ee .our doctor or 0oot care specialist

5se o1er$the$counter edications to treat corns and warts

A&&l# heat with a hot water bottle or electric blanet 7 a. cause

burns unnowingl.5oak.our 0eet

(ae 1er. hot $aths

5selotio $et!ee #o+r toes

8al $are)ootinside or outside

8ear ti.ht socks6 .arter or elastics or kee hi.hs

8ear o1er$the$counter insoles 7 a. cause blisters i0 not right 0or.our 0eet

;it 0or long periods o0 tie


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;tructural

Abnoralities

Peripheral

Arterial

Assessent

;in changes

E1idence o0 in0ection

Callous or ulcer


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Ra&i( 5creei. )or Dia$etic Ne+ro&ath# Usi.

10 .ra, 5e,,es*4eistei Moo)ila,et

=oss o0 sensation o1er the distal plantar sur0ace to the #&g

ono0ilaent is a signi0icant and independent predictor o0 0oot

ulceration and lower$e9treit. aputation!


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4ho is at %i.h Risk o) De-elo&i. a Foot

Ulcer8

> Peripheral neuropath.

7 Moo)ila,et sesatio loss

> Pre1ious ulceration or aputation

> ;tructural de0orit. or liited ?oint obilit.

> Peripheral arterial disease

> @icro1ascular coplications

> Ele1ated A#C> n.cho.cosis


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Foot ulcer

present

igh ris 0or

ulcer


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igh ris 0or

ulcer

Foot care education

Pro0essionall.$0itted

0ootwear

Propt re0erral to

ultidisciplinar. tea withe9pertise in 0oot ulcers

)0 ulcer

de1elops

%i.h Risk )or Ulcer9 Pre-etio a( Earl#

Treat,et


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=ocal 0actors

;.steic

0actors

8ound care

Pressure o00loading

Debrideent

*nonischeic wounds-

Gl.ceic control

(reat in0ection

Address lower$e9treit.

1ascular status

Foot Ulcer9 M+lti(isci&liar# Tea, A&&roach


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#! )n people with diabetes, )oot e7a,iatios b.

healthcare pro1iders should be an ite.ral

co,&oet o0 diabetes anageent to identi0.

persons at ris 0or ulceration and lower$e9treit.

aputation Grade C, =e1el 3and should be per0ored

at least a+all#and at ,ore )re:+et inter1als in

those at hi.h riskGrade D, =e1el

Reco,,e(atio 1


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guidelines!diabetes!ca " #$%&&$BA'()'G *22+$%+- "diabetes!caCop.right / 2 Canadian Diabetes Association

Reco,,e(atio 1 ;coti+e(

>? E-i(ece is c+rretl# lacki. to s+&&ort the

routine use o0 a(@+cti-e !o+(* heali.

thera&ies such as topical growth 0actors,

granuloc.te$colon. stiulating 0actors, deral

substitutes, or B( in diabetic 0oot ulcers but

the. a. be considered in nonhealing,

nonischeic wounds when all other options ha1ebeen e9hausted Grade D, =e1el

2013


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guidelines!diabetes!ca " #$%&&$BA'()'G *22+$%+- "diabetes!caCop.right / 2 Canadian Diabetes Association

CDA Cliical Practice +i(elies

www!guidelines!diabetes!ca7 0or pro0essionals

#$%&&$BA'()'G *22+$%+-

www!diabetes!ca7 0or patients
http://guidelines.diabetes.ca/http://diabetes.ca/http://diabetes.ca/http://guidelines.diabetes.ca/

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