Diabetes spurred nurse to become foot-care specialist

By Chris Baur Feb. 28, 2008

When Cheryl Best found out she had diabetes, she was shocked.

And very afraid.

“I was afraid of developing the diabetic foot. And then losing it. That was something I would not allow to happen to myself.”

As a registered foot-care nurse, Best takes foot care very seriously and believes everyone else should too.

In fact, too many people already neglect their feet. And this can lead to a series of foot problems, according to Best.

Some of these problems can include fungal infection, overgrown nails and calluses. In the worst care, amputation may occur.

“I’ve worked on people who have not properly looked after their feet and some have even lost toes, which can lead to imbalance,” said Best. “Looking after your feet is important because everything starts at the foot.”

As a mobile foot-care nurse, Best goes right to the client, sometimes seeing several a day.

It’s a line of work she loves.

For years, Best worked as a registered nurse, but when she developed diabetes she realized the importance of healthy feet.

It was then she decided to specialize in the field. She hasn’t looked back since.

Best said simple foot care is not hard to maintain, and should be done at least every six weeks. That’s especially true during winter.

“Winter is hard on the foot. It is essential to look after it during this time of year. Because winter is so dry, most people’s feet will crack, bleed and become extremely sore.”

Best has seen her fair share of unhealthy feet.

“This one client was elderly and couldn’t look after her own feet. When I saw her, there was nothing I could do. The toes looked like the beak of a parrot.”

Best had to send her to a podiatrist.

“Many people confuse me as a foot doctor, which I’m not. A podiatrist does more extensive work, such as surgeries. I do more of the maintenance on the foot.”

And depending on the condition of a person’s foot, Best said the time spent on it could be anywhere from a half hour to an hour.

Wendy Cathcart, a client of Best’s, has to have her feet looked after on a regular basis.

“Because I’m older, I can’t cut my nails by myself. The massage I have done on them gets my circulation going and this helps me to walk better.”

Nurse traveled to Africa to treat foot wounds caused by diabetes

Laura Roehrick, RN, CFCN, takes a feet-first approach toward diabetes care.

Armed with a high-speed drill, burrs and bits and an unusual technique, Laura Roehrick, RN, CFCN, worked on the miguu of many patients in Dar es Salaam, Tanzania.

Roehrick traveled halfway across the world to teach proper foot care to African doctors as a faculty member of Step by Step, a program funded by the World Diabetes Foundation and International Diabetes Federation that aims to improve diabetic foot care in developing countries.

“My goal going into Africa was to see with my own eyes what is happening there,” Roehrick, a foot care nurse and owner of the The Foot Care Connection, told Endocrine Today.

Diabetes is an epidemic in Africa. On her first day there, a taxi driver told Roehrick that many people in Tanzania drink 10 or more sodas per day. Few people know about diabetes or related dietary concerns, she said.

Foot clinics are rare in developing countries. Step by Step’s team estimates it can reduce the number of amputations by 50%.

“My mission is based on a fact I discovered 13 years ago – 85% of amputations that occur because of diabetes are preventable,” she said. “Why are we not doing a better job at preventing it?”

Rustic clinic

In Dar es Salaam, Roehrick spent four days in an underfunded, rustic clinic where she trained four nonmedically-trained staff members. Infection control had been inadequate before her arrival. The staff would sterilize the basins and wear gloves, but they would not wash their hands in between patients.

Some of the foot conditions of the patients were appalling, according to Roehrick, and almost all were related to diabetes. Many people in Tanzania do not wear shoes, leading to dry, callused feet. No one was addressing the resulting skin care conditions.

“One woman had a wound for seven years that was not healing. People had parts of toes missing, rat bites on numb feet,” she said. “Before I came, [the staff] would just change the dressings on these wounds in very primitive conditions, and the wounds wouldn’t heal.”

Roehrick left the team with a high-speed drill and burrs and bits to sculpt the feet, as well as textbooks and hands-on training.

“I taught them a new way of doing things. I would sculpt the nails and calluses of each patient who came in, using the drill, and pretty soon the staff was doing it and I was observing it,” she said.

Roehrick started The Foot Care Connection, based in Santa Rosa, Calif., 13 years ago. She was the first nurse in California to open an independent foot care practice.

“Foot care is something that nurses in this country, to this day, are still told we cannot do,” she said. “But, it is within our scope of practice and nobody knows about it.”

Roehrick’s focus is on diabetes amputation prevention. Ninety percent of amputations begin with a callus, a callus fissure, an ingrown toenail or nail problem, she said.

“My specialty is the worst of the worst nails and calluses you have ever seen. I use a high-speed electric podiatrist drill and I sculpt them. I’ve developed a technique that I haven’t seen anyone else do quite like me. I take burrs and bits from different industries that aren’t traditional, and I sterilize them and sculpt the feet without a scalpel – sterile, painlessly, effectively,” Roehrick said.

Moving forward

While in Africa, Roehrick also traveled to Uganda and Zanzibar. In Zanzibar, she met with Fadhil M. Abdalla, a family practice doctor there with a special interest in diabetic foot care.

Her experiences and observations in Africa, coupled with her meeting with Abdalla, prompted her to begin the long process of starting her own nonprofit, hoping to improve foot care in Africa, specifically in Zanzibar.

“I want to try to prevent that first wound in developing countries and get education at that base level,” Roehrick said. – by Katie Kalvaitis

Podiatry Gone Bad

Podiatrist murdered a former patient just days before she was to testify

---

Case against podiatrist is laid out
Murder covered up fraud, jury is told

By Matt O'Connor
Tribune staff reporter
Published April 20, 2005


A Chicago podiatrist murdered a former patient just days before she was to testify against him in a fraud probe because the doctor believed she would be the lone witness against him, a prosecutor said Tuesday.

But a lawyer for Dr. Ronald Mikos tried to debunk that central government theory, pointing out that the massive investigation had uncovered that nearly 100 patients were victimized as part of the Medicare fraud.

"Killing one patient could not possibly end that investigation," Cynthia Giacchetti, one of Mikos' lawyers, told a federal jury in opening statements.

Assistant U.S. Atty. Jeffrey Cramer charged that Mikos shot Joyce Brannon three times in the back and then put the gun against the flesh of her neck and fired three more times, emptying his revolver. Brannon, 54, a disabled caretaker, was killed in the basement apartment of the North Side church where she lived and worked.

If Mikos is convicted of Brannon's murder, prosecutors intend to seek the death penalty from the same jury.

In addition to the murder, the 25-count indictment charges that Mikos, 56, defrauded Medicare of more than $1.2 million by falsely claiming to have performed more than 6,000 surgeries. He is also accused of obstructing justice by recruiting patients to lie to investigators about the fraud.

In opening remarks to jurors, Cramer said Mikos knew that Brannon was among the patients of interest to investigators after he voluntarily met with a prosecutor and agent in the fall of 2001 to try to convince them he had performed all 6,000 surgeries.

By early 2002, Brannon and three others had been subpoenaed to testify before a federal grand jury. One prospective witness, Charles Lobosco, was taking kickbacks from Mikos as part of the fraud scheme and Lobosco's daughter, another would-be witness, was mentally disabled and not a threat to Mikos either, Cramer said.

The other potential witness, an elderly woman, had led Mikos to believe she wouldn't testify against him either, Cramer said.

"Only Joyce Brannon stood in his way," the prosecutor told jurors. "He had to do something."

Three days before the murder, Mikos retrieved several firearms of his from Skokie police and called Brannon to plead with her not to testify. But Brannon later told her sister and a friend of the call and said she had refused to lie for Mikos.

After Mikos' arrest, the FBI recovered all the firearms in a storage facility rented by Mikos--except for a .22 caliber revolver that authorities believe was used to kill Brannon. An exhaustive search didn't turn up the gun, Cramer said.

In her opening remarks, Giacchetti cautioned jurors not to be swept up by the emotion of the case. She recounted how Cramer had dramatically described certain murder details in his opening but pointed out that Mikos wasn't seen anywhere near Bethany Evangelical Lutheran Church, 5942 N. Magnolia Ave.

And no physical evidence connects him to the murder scene either, Giacchetti said.

Giacchetti scoffed at the government contention that Brannon was key to the prosecution case, saying, "There were 90 other patients."

Source Chicago Tribune

http://www.chicagotribune.com/news/l...ck=1&cset=true

World Foot Health Awareness Month 2008

May this year has been designated World Foot Health Awareness Month. Although the SCP is not promoting it’s feet for life month this year, as a member of the International Federation of Podiatrists, we actively endorse and promote this initiative to members, and encourage members to take part and promote foot health in their local area.

A guide to World Foot Health Awareness month has been produced by members of the World Foot Health Awareness Committee who are keenly aware of the importance and value of Foot Health Awareness Month to members of the podiatric profession and to the public we serve.

The guide is divided into three sections:

Section 1 – Public Relations.
This contains sample press releases, talking points for speeches and articles, Head of School letter, sample 30-second public service announcements, European-wide media outlets, sample declaration statement, FAQ’s about foot Care and the top 10 foot problems

Section II – Public Information
This contains a true and false questionnaire on general foot health, travel tips – ideas for good foot health when travelling, ten tips for healthy feet, FIP member websites, and recommendations for starting a walking programme.

Section III – Foot Health Information
This contains what you should know about your podiatrist and the podiatric profession, tips for buying shoes for adults and children; and examples of common foot and ankle ailments, including diabetic ulcers, corns, callus, bunions, ingrowing toenails, fungal nail infections, etc.

The guide is designed so that podiatrists can use the information in a variety of ways, either in printed form or online. As FIP continues to grow and progress, it is hoped that the guide will become an increasingly valuable resource for the international podiatric medical community.
In addition, the Committee has prepared a poster for member associations to mark World Foot Health Awareness Month. This year’s poster, modelled on the 2005 poster, a foot ready to launch an Olympian, is shown on the facing page.

The Committee has also prepared a Corporate Advisory Board (CAB) Guide that will provide essential information for members in order to facilitate cooperation between FIP members and members of the CAB.
This year, the Special Focus Section entitled: ‘Special Olympic Athletes and their Foot Health Problems’, will be printed separately from the Resource Guide. The Special Focus Section is replete with valuable information on the role of the podiatrist in meeting the foot health needs of these special athletes.

World Foot Health Awareness Month Committee
Kel Sherkin, Canada
Margrét Jónsdóttir, Iceland
Mike Erchen, South Africa

The World Foot Health Awareness 2008 guide and poster are available to download from the FIP website: www.fipnet.org

Soc Chiropodists & Podiatrists 2-Feb-2008
Categories: Ingrowing toenails , Footnote, Corns , Common Foot Problems, Callus , Bunions, Keeping Feet Healthy

www.feetforlife.org/cgi-bin/item.cgi?2020

Foot care provider aims for eco-friendly natural formulations

By Simon Pitman

12-Feb-2008 - Tapping into the need for personal care products dedicated to more mature consumers, the market for foot care products is set to boom, but success means that products also have to follow key market trends.

The CEO of personal care distribution company Xenna, Carol Buck, says she is clued into the fact the graying baby boomers are feeding demand for increasingly functional and effective foot care products that treat key problems such as dry and chapped skin.

But merely marketing a foot care product that caters to these requirements is not enough.

Buck believes that crucial to success in this growing niche market is to tap into one of the biggest trends in the personal care segment as a whole - demand for natural-based formulations.

"Whenever we formulate a product we start with natural ingredients," Buck said. "Our customers continuously tell us that they like simple, natural ingredients in personal care products."

Sustainability goes hand-in-hand with natural

But almost hand-in-hand with naturals comes the issue of sustainability, which in relation to both the packaging and formulation of personal care products is also increasingly important.

A recent study conducted by Information Resources (IRI), indicates that roughly half of all Americans factor in at least one sustainability issue when buying a consumer product.

"We see a connection between natural ingredients and a greener environment because natural ingredients reduce the earth's chemical recycling burden," Buck said.

The company offers a range of innovative treatments for both feet and toenails that specifically target conditions affecting people aged 50-plus, particularly diabetics who suffer from foot conditions..

One of these products is NonyX Nail Gel, which addresses the problem of toenails that have become unattractive due to discoloring as part of the aging process.

Foot care goes ultra targeted

The company says that this product helps to remove keratin build-up, which is responsible for a yellow or granular effect over time, giving the toenail an unhealthy and rough-looking appearance.

Xenna also markets CalleX dry heel ointment, which specifically targets this hard-wearing part of the foot.

Likewise, treatments are also offered to this age group under the Olay brand, which include a thermal pedicure treatment that particularly targets dry areas of the foot that crack and add to an overall aging look to the feet.

These type of natural-based foot care products are rapidly contributing to a market that Packaged Facts believes will help develop the current natural and organic market into a $10.2bn industry by the year 2012.

Practitioners face facts in footcare treatments

BioMechanics
November 2007

By: Michael B. Strauss, MD, and Stuart S. Miller, MD

There are many myths, fallacies, and misconceptions about the skin of the feet and the toenails of patients with diabetes, and the care that they require. Physicians who understand the reality behind these misconceptions are better equipped to address them and provide improved patient care.

Common myths include:

• If a foot skin integrity or toenail problem in a patient is not noted early, it is nothing to worry about.
• Management of a foot skin or toenail problem may be futile or have only short-term benefits.
• Neuropathy is the direct cause of diabetic foot wounds and the reason why healing is so difficult.
• Amputation is a sign of management failure.
• Patient noncompliance is always the patient's fault.

Objective evaluation, appropriate management, and rational prevention of injury to the foot skin and toenails in diabetic patients can expose the myths and misinformation and help keep these patients healthy.

Out of sight, out of mind

Ignoring a problem is almost never a good idea.

Myth: Because a problem in the skin integrity of the feet or toenails is not noted immediately, it is OK to assume that the problem is not important.

Reality: Almost all problems that become limb-threatening in patients with diabetes begin with a minor foot skin or toenail problem. Patients probably have less awareness of what is happening in these structures than in any other external portion of their bodies. The feet and toenails are the most remote from vision and smell, the senses most likely to detect the earliest problems, and they are covered with socks, footwear, and bedding materials almost all the time. Because they are remote from the hands, the feet and toenails are often difficult for the patient to examine and initiate care measures, a problem compounded by restrictions in mobility resulting from obesity, arthritis, and aging. Sensory neuropathy may delay diagnosis of foot skin and toenail problems because pain perception associated with injury or infection is absent in these structures.

Advice: Patients who have diabetes, and their caregivers, need to examine the skin of their feet and their toenails routinely (Table 1). They should do so before they don socks and shoes, after they remove them, and after they bathe.

Physicians should ask patients who have significant sensory neuropathies to wear white socks so that any break in skin integrity may be recognized immediately because of the resulting stain visible on the sock. Patients should be advised to bring the first sign of a problem in these structures to the attention of their primary care physician, diabetes educator, or foot surgeon. Physicians may use visual inspection to start their evaluation of foot skin and toenail problems.

An exercise in futility?

Management is a constant challenge.

Myth: Once a problem in the foot skin or toenail is identified, management may be futile or result in only short-term benefits.

Reality: Several factors contribute to this misconception. Because the foot skin and toenails are at the most distal portions of the circulatory system, they have the poorest blood supply, especially when concomitant peripheral arterial disease is present. In addition, they are in the part of the body most likely to be affected by neuropathy.

Although skin and toenail problems may be slow to heal because of peripheral arterial disease, most eventually do heal. The following are five potential management strategies:

• surgical management of the wound base and, if necessary, correction of deformities;
• appropriate immobilization and protection of the wound site;
• optimal medical management, especially involving diabetes care;
• selection of the most suitable agents to cover the wound; and
• enhancement of wound oxygenation, which may require hyperbaric oxygen treatments as an adjunct to management.1

Advice: Healing the wound and correcting toenail disease are primary goals. However, preventing new or recurring wounds is also important. An effective four-strategy program includes:

• patient education;
• skin and toenail care;
• appropriate footwear choices; and
• proactive surgeries.

The importance of the last strategy cannot be overemphasized. Deformities are a prime reason, along with inadequate blood supply and refractory osteomyelitis, why the wounds do not heal and why they recur after healing.2 If attention is not paid to this essential strategy, unsatisfactory treatment results or recurrences of problems after nonoperative management, including total contact casting, are likely.

Neuropathy-bane and boon

Sensory loss can compound other problems.

Myth: Neuropathy is the direct cause of diabetic foot wounds and toenail problems and the reason why healing is so difficult.

Reality: This is probably the most widely propagated misconception about diabetic wounds. Neuropathy itself is not a direct cause of wounds and toenail problems.3 Neuropathy may delay diagnosis of a wound or toenail problem, lead to a deformity, or contribute to making the skin more vulnerable to stresses (Table 2), but it does not interfere with healing. In addition, in almost all situations, diabetic neuropathy is not a correctable condition.

Advice: Accept neuropathy for what it is: a bane-it causes loss of protective sensation, muscle imbalances, and autonomic dysfunction-and a boon-sensory neuropathy facilitates almost painless wound care with consideration to dressing changes and debridements and requires minimal anesthesia when proactive surgeries are performed. Autonomic neuropathy also may contribute to increased blood flow, an essential element for wound healing. Almost all patients with diabetes who use the appropriate prevention strategies avoid future wound and toenail problems and maintain functional use of their feet, even if they have profound neuropathies.

Amputation-a measure of success?

The decision to amputate is complex and involves a myriad of factors.

Myth: The need to amputate is a sign of failure in the management of disease.

Reality: Lower extremity amputations, ranging from partial toe to hip disarticulations, must be placed in proper perspective. They do not necessarily reflect a lack of management success, especially if the five management strategies have been used. Amputations may bring closure to long-standing problems and allow the patient to resume functional activities that were not otherwise possible. There are five major reasons for lower limb amputations: nonmanageable ischemia, uncontrolled infection, structural problems that prevent functional use of the extremity, coexisting collagen vascular diseases, and intractable pain.1

Advice: Determination of the level of amputation is usually obvious when one or more of the five reasons are present. When alternatives exist as to the level of amputation, the surgeon needs to provide probability for healing and functional recovery to the patient or designated healthcare proxy. With an infected toe joint, for example, the probability of healing when the joint is removed and the toe is shortened may be 50%, but with a toe amputation, the probability of healing would approach 100%. With the proper selection of footwear, no differences in function are likely to be noted with either approach. Special consideration must be given for performing amputations when intractable pain is present, even if the wound is remediable. To maximize function, amputation should be performed at the most distal level where healing is likely to occur.

Patient compliance in perspective

Practitioners must consider their patients' abilities and limitations when expecting them to manage their own disease.

• Myth: Poor patient compliance is the reason for failures in managing and preventing foot skin and toenail wounds in patients who have diabetes.
• Reality: Like amputations, patient compliance must be placed in proper perspective. Labeling a patient as noncompliant because management and prevention recommendations are not followed may be inappropriate. Use of these measures may be impossible for some patients because they have limitations in mobility (e.g., in donning and removing elastic support hose to control edema), a lack of resources for supplies and help, or a combination of these difficulties. Patients' care providers should appreciate these compliance issues and explore all possible measures for resolving them-the cost of a single day of hospitalization will cover many weeks of home healthcare or homemaker services.4
• Advice: Physician and diabetes educators need to make measures for ensuring compliance with all aspects of diabetes care-including care of the skin of the feet and the toenails-an integral part of their encounters with patients and their caregivers. Simplified assessments for skin and toenail evaluation and management provide objective criteria for determining which interventions need to be carried out. In addition, calculating a goal-aspiration score that quantifies patient goal-related assessments offers information about compliance and provides guidelines for determining how often follow-up visits are needed.

Michael B. Strauss, MD, is medical director and Stuart S. Miller, MD, is education coordinator of the hyperbaric medicine department at the Long Beach Memorial Medical Center in Long Beach, CA.

A version of this article originally appeared in our sister publication, the Journal of Musculoskeletal Medicine, in August 2007.

References

1. Strauss MB, Pinzur MS. Treatment strategies for managing problem diabetic foot wounds. In: 68th Annual Meeting Proceedings, American Academy of Orthopaedic Surgeons, 2001;2:675-676.
2. Strauss MB. Diabetic foot problems: keys to prompt, aggressive therapy. Consultant 2002;42:81-93.
3. Strauss MB, Miller SS. Diabetic foot problems: keys to effective, aggressive prevention. Consultant 2007;47:245-252.
4. Consensus Development Conference on Diabetic Foot Wound Care: April 7-8, 1999, Boston. American Diabetes Association. Diabetes Care 1999;22:1359-1360.

Patient Do's and don'ts to prevent foot skin and toenail problems in the diabetic foot

Do

Inspect feet for pressure sores and skin irritation after removing shoes

Inspect socks for stains when they are removed; if sensation in feet is reduced, wear white socks

Use the appropriate footwear as recommended by healthcare professional

Perform daily foot skin care

Maintain an "open line" to a primary care physician to discuss the first signs of any foot skin or toenail problems

Don't

Walk barefoot

Use heating devices on feet

Soak feet in hot water

Use chemicals or sharp instruments to trim calluses

Trim toenails if sensation in feet is reduced, vision is impaired, or mobility is limited

Copyright: 2007 CMP Media, LLC

Understanding the Do's and Don'ts of Diabetic Foot Care

Persons with diabetes routinely attend diabetes teaching clinics where they receive valuable diabetes education. A lot of different information is presented including lists of Do’s and Don’ts of foot care. In order to follow or adhere to a list of do’s and don’ts of foot care it is important to understand the list. As a diabetic foot care specialist I commonly ask new patients what they have learned about foot care. Some are able to repeat a list of do’s and don’ts. When I respond by asking, “Why should do this or why shouldn’t you do that?” the common answer is because, “If I don’t I could lose my leg or Uncle Joe lost a leg to diabetes…”

It is a fact that persons with diabetes have a higher risk for leg amputation than persons without diabetes. It is also true that persons with diabetes are individuals. The effect of diabetes will vary from individual to individual. Likewise the feet will be affected on an individual basis. Some persons will be at extremely high risk for foot problems and amputation; whereas, others may not be at much more risk than an average person without diabetes.

There are four risk factors that increase a person’s risk for diabetes related foot troubles. First and foremost is peripheral neuropathy or loss of feeling. Without feeling the individual may not be aware of foot troubles until it is too late. Prior history of foot troubles, circulatory troubles and deformity (hammertoes, bunions, thick toe nails, calluses etc) comprise the other three risk factors. Health care providers can screen for these factors very easily. The more risk factors the greater the risk for eventual troubles.

Persons with diabetes who are found to be at increased or high risk for foot troubles must take steps to prevent diabetic related foot problems. As a person with diabetes it is thus extremely important to know your risk status for foot troubles. If you understand the risk factors and implications then it is easy to understand why “you should do this or shouldn’t do that”. So the next time someone asks you why you should or shouldn’t do this or that try responding by saying “because I have or don’t have neuropathy, deformity, prior history and circulatory troubles and my risk is …” If your foot health care provider has not discussed your individual risk for foot problems then bring it up at your next scheduled visit.

Do:

Have your shoes professionally fitted Inspect your feet daily Dry between your toes Wash your feet daily Have your feet checked regularly by a foot health care professional (frequency of visits is on an individual basis) Use moisturizing creams if your feet are dry

Don’t:

Walk barefoot Cut the corners of your nails Cut your own corns or calluses Soak your feet Smoke

Timothy P. Kalla, BSc, DPM, FACFAS

bcfootandankle.com

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DO'S AND DON'TS FOR DIABETIC FEET

DO'S AND DON'TS FOR DIABETIC FEET
DO's for Diabetic
l Inspect the feet daily for blisters, cuts, and scratches. The use of a mirror can aid in seeing the
bottom of the feet. Always check between the toes.
l Wash feet daily. Dry carefully, especially between the toes.
l Avoid extremes of temperatures. Test water with hands or elbow before bathing.
l If feet feel cold at night wear socks. Do not apply hot water bottles or heating pads. Do not soak
feet in hot water.
l Inspect the inside of shoes daily for foreign objects, nail points, torn linings, and rough areas.
l If your vision is impaired, have a family member inspect feet daily, trim nails, and buff down
calluses.
l For dry feet, use a very thin coat of lubricating oil such as baby oil. Apply this after bathing and
drying the feet. Do not put the oil or cream between the toes. Consult your physician for detailed
instructions.
l Wear properly fitting stockings. Do not wear mended stockings. Avoid stockings with seams.
Change stockings daily.
l Shoes should be comfortable at the time of purchase. Do not depend on them to stretch out. Shoes
should be made of leather. Running shoes may be worn after checking with your physician.
l In winter take special precautions. Wear wool socks and protective footgear, such as fleece-lined
boots.
l Cut nails straight across.
l Avoid crossing your legs, as this can cause pressure on the nerves and blood vessels.
l See your physician regularly and be sure that your feet are examined at each visit
l Be sure to inform your podiatrist or chiropodist that you are a diabetic.
DONT'S for Diabetics
l Do not smoke.
l Do not walk on hot surfaces such as sandy beaches or the cement around swimming pools.
l Do not walk barefooted.
l Do not use chemical agents for the removal of corns and calluses.
l Do not use corn plasters.
l Do not use strong antiseptic solutions on your feet.
l Do not use adhesive tape on the feet
l Do not soak feet
l Do not wear garters.
l Do not wear shoes without stockings.
l Do not wear sandals with thongs between the toes
l Do not cut corns and calluses.
Follow special instructions from your physician or podiatrist
REMEMBER TO INFORM EVERY DOCTOR THAT YOU ARE DIABETIC
DIABETIC FEET

Self Assessment Quiz

Foot Care You are in Foot Care > Self Assessment Quiz. Self Assessment Quiz The Foot Health Foundation of America offers this simple quiz to pinpoint any warning signs of foot and ankle problems: (See bottom for scoring.) 1. How much time do you spend on your feet each day? a. less than 2 hours b. 2 - 4 hours c. 5 - 7 hours d. 8 hours or more 2. How old are you? a. under 40 b. between 40 and 59 c. 60 and over 3. How would you describe your weight? a. less than 20 pounds overweight or at ideal weight b. 20 - 39 pounds overweight c. 40 or more pounds overweight 4. Have problems with your feet or ankles ever prevented you from participating in: a. leisure/sports activities? Yes No b. work activities? Yes No 5. Have you ever received medical treatment for problems with your feet and/or ankles? a. yes b. no 6. Do you regularly wear heels two inches or higher? a. yes b. no 7. What types of exercise do you engage in or plan to engage in? (check all that apply) a. walking b. field sports (e.g., softball, golf) c. winter sports (e.g., skiing, ice skating) d. court sports (e.g., tennis, basketball) e. aerobics f. running g. none (if you chose answer g, skip to question 11) 8. Do you have the appropriate shoes for your sport or sports? a. yes b. no 9. Do you experience foot or ankle pain when walking or exercising? a. rarely b. sometimes c. often d. never 10. Do you: a. exercise in footwear that is more than one year old or in hand-me-down footwear? Yes No b. stretch properly before and after exercising? Yes No 11. Do you: a. have diabetes? Yes No b. experience numbness and/or burning in your feet? Yes No c. have a family history of diabetes? Yes No 12. Do you: (check all that apply) a. sprain your ankles frequently (once a year or more) or are your ankles weak? b. have flat feet or excessively high arches? c. experience pain in the achilles tendon or heel or have shin splints (pain in the front lower leg)? d. have corns, calluses, bunions or hammertoes? e. have arthritis or joint pain in your feet? f. have poor circulation or cramping in your legs? Your Total: Scoring 0 - 20 points: Congratulations! Your feet and ankles are very healthy and you can maintain your active lifestyle and/or exercise regimen. With proper attention and care your feet and ankles should remain healthy; however, you may want to schedule an annual exam with our office to ensure their long-term health. Furthermore, if you scored points for questions 4, 5, 9, 11 or 12, you should contact our office in the near future for a check-up. 21 - 40 points: Pay attention. Your feet and ankles are showing signs of wear, placing you in the moderate risk category. Although you can continue your normal activities, you should contact our office for a check-up. If you participate in a rigorous exercise regimen on a regular basis or plan to - or if you scored points for questions 4, 5, 9, 11 or 12 - you should contact our office soon to safeguard your foot and ankle health. 41 points or higher: Caution. Your feet and ankles are at high risk for long-term medical problems and you should contact our office as soon as possible. If you exercise, you should pay particular attention to your feet and ankles until you are seen by our practice. If you have not begun exercising, it is advisable to contact our office before undertaking any type of exercise. Now that you've assessed the health of your feet and ankles, you are armed with knowledge that will enable you to maintain their health over a lifetime.

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New foot ulcer treatment and foot surgeries and

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How Foot Smart Are You?

Foot Facts

How Foot Smart Are You?

Take these quizzes to see how much of a Footcare Expert you are!
(Answers can be found at the bottom of the page.)

DID YOU KNOW...
More than 70% of all people in the United States will have painful foot problems at some time during their lifetime.
Foot pain is not normal.

Quiz I

Some famous people down through the ages have made memorable statements about feet or have otherwise influenced the way we think about feet and shoes. Can you identify the person connected with the following?

1. Which Greek philosopher said, "When our feet hurt, we hurt all over"?
   1. Plato
   2. Socrates
   3. Aristotle
2. Which Renaissance artist called the foot "a masterpiece of engineering and a work of art"?
   1. Leonardo da Vinci
   2. Raphael
   3. Michelangelo
3. What hero of ancient Greece gave his name to the largest and strongest tendon in the foot?
   1. Ulysses
   2. Jason
   3. Achilles

DID YOU KNOW...
The average person, engaging in non-strenuous activity, walks approximately 4 miles every day or about 115,000 miles in a lifetime.

Quiz II

Use these numbers to answer the following questions about parts of the foot - 5, 20, 26, 33, 100

1. How many of the body's 206 bones are located in each foot?
2. How many joints hold these bones together?
3. How many muscles are used to move the bones of each foot?
4. How many ligaments join these bones?
5. (This one's easy...) How many nails protect the toes of each foot?

DID YOU KNOW...
During a typical day, the feet endure a cumulative force of several hundred tons.

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Answers to Quiz I:
1)B 2)A 3)C
Answers to Quiz II:
1) 26, 2) 33, 3) 20, 4) 100, 5) 5

YES, IT'S TRUE...
The human foot is a highly specialized structure containing 26 relatively small bones, more than 150 ligaments and an intricate network of muscles, nerves and blood vessels.

Foot Ulcers

Foot ulcers are generally a breakdown of the skin on the plantar aspect (bottom) of the foot. They have many causes, but the most common are diabetes, and vascular insufficiency. Diabetes or vascular insufficiency should be taken very seriously as a good warning sign of impending loss of limb.

Self-treatment is not recommended for this serious condition. Consultation with a podiatrist, orthopedist, vascular surgeon, or family doctor is recommended. Some of the things that these physicians will do are:

• Ascertain whether or not there is diabetes through a blood test and/or
• Obtain x-rays to determine if there is any bone involvement

If the pulses are diminished then a doppler is indicated to determine the extent of the circulation.

If there is a decrease in circulation then referral to a vascular surgeon is indicated.

The next step is to determine the level of the blockage of the artery. If the artery is blocked in a specific point, then various surgical procedures can be employed. Balloon Angioplasty, laser Angioplasty and stents are employed to open up the blood flow to the foot.

But again, any break of the skin on the plantar (bottom) of the foot is a serious condition and can result in loss of the limb. Immediate referral to a professional is indicated.

Charcot Foot

Charcot arthropathy (Charcot Foot) is a progressive disease of neurologic origin. It is a key concern for diabetics.

Jean-Martin Charcot, a French neurologist, is given credit for first describing this disease in the 1800's, although he primarily attributed it to complications of syphilis. The first published report of diabetes as a causative factor in Charcot arthropathy was reported in 1936. And today, Charcot arthropathy is primarly associated with diabetes.

Charcot arthropathy usually affects the foot and the ankle joints. Type II diabetics in particular are most prone to the ravages of neuropathic changes in the lower extremities. Neuropathy is prevalent in up to 7% of diabetic patients.

Classification

Neuropathic arthropathy is either atrophic (wasting away or decrease in size of the body part) or hypertrophic (growing abnormally large).

The atrophic form is usually localized to the forefoot and causes degeneration of bone tissue of the distal metatarsals. The hypertrophic form usually occurs at the mid tarsal joints (center joint of the foot) usually referred to as the Lisfranc articulation. Less commonly but equally destructive is the ankle articulation including the subtalar joint. Patience and the subacute Charcot phase present with resorption of bone debris. The consolidation or repaired of stage which is the chronic Charcot type foot is associated with stabilization of the foot with fusion of the involved fragments.

Diagnosis

The first step in treating in Charcot arthropathy is obviously making the correct diagnosis. This is not always easy to do. Trauma is not usually a precipitating event, and charcot arthropathy usually presents as a slow and gradual onset, characterized by increased warmth, edema and sometimes increased temperature. The symptoms of Charcot arthropathy are often confused with cellulitis. Cellulitis is an infectious condition that usually affects the foot, ankle and legs and has the same characteristics. But with Charcot arthropathy there is no infectious agent that can be identified and it is not amenable to antibiotic therapy. However, many Charcot arthropathies have ulceration associated.

In the beginning phases of this disease, plain film x-rays are usually not helpful. Magnetic resonance imagine is the best diagnostic tool. Other tests that are helpful include white blood counts and sedimentation rate.

The underlying condition of Charcot arthropathy lies in the neurologic diagnosis: loss of sensation which is characterized by decreased sensitivity to light touch, cold, heat and pressure. The monofilament test which measures how much pressure loss has taken place is a good screening device to detect degenerization of the the nerves in diabetics. However, if the diagnosis is in question, quantitative sensory testing is the best diagnostic tool. Also used for diabetic Charcot arthropathy is an older technique called bone scanning. Indium radionucleotide sometimes can help differentiate infection from Charcot arthropathy.


Treatment

What can YOU do?

• Institute complete non-weight bearing for the affected extremity - that means keep your weight off the foot
• Maintain good glycemic control
• Guarding against infection
• and educate yourself about total outcome of this severe disease.

Newer techniques to re-establish sensitivity to the extremity have been pioneered by Johns Hopkins University professor Dr. A. Lee Dellon. This technique decompresses multiple peripheral nerves in the lower extremity and 85% of the cases have been shown to have excellent results. However, this technique needs to be instituted before complete bony destruction has ensued. If the neuropathy is not reversed, outcomes are poor.

Surgery

In advanced cases of Charcot arthropathy where bone destruction has taken place, reconstructive surgery can be performed. This technique usually requires extensive surgical reconstruction with either internal or external fixators.

In the interim, before surgical care is instituted, non-weightbearing full-contact casting is employed. But even with these techniques, amputation of the extremity is still inevitable in a large percentage of cases. It is estimated that 100,000 non-traumatic amputations occur every year in the United States.

In summary, Charcot arthropathy is a devastating disease that is difficult to diagnose, usually has poor outcomes, and is extremely expensive to treat.

Neuropathy

Neuropathy is the loss of sensation, and it is the number one disease that affects the diabetic that leads to loss of limb.

Neuropathy is usually characterized by phases:

• Phase I of neuropathy is a tingling sensation in the plantar aspect (bottom) of the foot that may manifest as a feeling of bugs crawling or bees stinging, and this term is referred to as formication. This is a very important indicator that loss of sensation is happening.

• Phase II has the symptoms that come more frequently and are more intense.

• Phase III is characterized by a constant burning of the feet that causes disruptions in sleep. This phase usually requires medication such as pain pills or other medications such as Neurontin.

• Phase IV is characterized by moments of relief. The patient is falsely convinced that their disease is improving because there are moments of lack of pain; but really what is happening is that the condition is progressing into Phase V, which is not total relief of pain but complete loss of sensation. This is the most dangerous phase and this is when ulcers develop.

New tests have been developed to measure the loss of sensation. There are several devices that are classified as quantitative sensory testing. The best and most informative of these tests is the pressure specific sensory device (PSSD). To find out more about this device check out these two web sites: http://www.neuropathyweb.com and http://www.dellon.com.

Vibratory threshold devices are also helpful in ascertaining whether or not loss of sensation is occurring. The Semmens-Weinstein monofilament is also a good screening device for loss of sensation on the plantar aspect of the foot.

Treatment

When these conditions of loss of sensation are detected usually a neurologist, specially trained podiatrists or family doctor can treat this type of condition. The podiatrist is probably the first line of defense in the practitioner who treats the ulcerations that develop from this condition. It is important to seek out professional help before self-treatment. They will use devices to off-load the ulcerations, custom orthotics, diabetic shoes, antibiotics, foot soaks/baths and good diabetic hygiene.

Other useful treatments include massage, pain relieving gels, such as Neuro-Eze Neuropathy cream and Boswella Cream as affective relieve for neuropathic pain. Other treatments are vitamins such as Rodex Forte, and Dia Vite Vitamins.

The newest treatment for diabetic neuropathy from a medical standpoint is L-Arginine. A commercially available cream is NOW available ... Neuro-Eze, and also oral use of L-Arginine. L-Arginine is a semi-essential amino acid and in diabetics the levels are very low. L-Arginine is one of the building blocks of protein and it goes through the L-Arginine nitricoxide oxygen pathway. If there is not enough L-Arginine, as a precursor, then the production of nitricoxide cannot be established therefore the nerve is deprived of oxygen (anoxia) and that is thought to be the reason for the pain development. There is also a surgical procedure that was devloped by Dr. Lee Dellon that has been shown to be very effective in restoring sensation in the diabetic limb.

Diabetic Foot Care / Informational Video Links

Resource material regarding foot ulcers, recognizing potential
foot health problems, and everyday diabetic foot care.

http://www.youtube.com/watch?v=VdYrnRfgwXM&feature=related

http://www.youtube.com/watch?v=AHGIsZHdYnI&feature=related

http://www.youtube.com/watch?v=hNJAsrxz7qU

http://icyou.com/topics/feet

http://www.nlm.nih.gov/medlineplus/tutorials/diabetesfootcare/htm/index.htm

http://merrickfootcare.com/#/generalcarediabetic/4525748800

Finding Time for Foot Care

Nursing Homes, Sept, 2001 by Linda Zinn

Vigilance helps prevent complications with diabetic residents' feet

Mrs. Smith just had an accident while seated on one of the sofas in the living room. Mr. Brown is in the hallway looking for his cat which, in reality, has been gone for 50 years now. Mr. Thomas, a "wanderer," is attempting to convince an arriving group of visitors to take him to the store. It's time for Miss Jones to be accompanied to her physical therapy session. The therapy dog, usually placid and obedient, is running down the corridor dragging Mrs. Simpson's cane behind him, and Mrs. Simpson (not a big dog lover) is expressing (loudly) that she's not pleased. Oh, and on top of everything else, it's almost time for the noon meal and (by the way) the state surveyor has just arrived.

Although perhaps exaggerated a bit, this description of a "day in the life" of a skilled nursing facility isn't all that much of a stretch. There's no way to anticipate every crisis, major or minor, that could occur at any moment on any given day, placing additional demands on caregiving staff who are already hard pressed to keep up with the basics of daily resident care.

Some needs of residents are more obvious than other needs. For example, if residents didn't have their hair washed frequently enough or receive regular assistance with bathing, it soon would become evident. Feet, on the other hand, could easily be overlooked. For those diabetic residents who are at high risk of developing pressure ulcers on their feet, this oversight could be critical. The need for routine foot care, if ignored, could quickly escalate into the need for wound treatment.

Diabetics living in the community are encouraged by their physicians to follow a rather extensive list of self-care guidelines, including daily inspection of their feet and the inside of their shoes, daily foot washing and, if needed, moisturizing, but many diabetics living in nursing homes are not physically or cognitively able to follow these guidelines.

Some residents, for example, lack the joint flexibility required for a thorough foot inspection. Others simply forget to look at their feet or can't see well enough to identify potential problems- problems that they perhaps can't feel because of peripheral neuropathy. These individuals need help from caregivers. How can the already-overburdened staffs of nursing homes keep up with routine foot care for these residents?

Jean DeCamp, RNC, director of nursing at Village North Health Center in St. Louis, says the foundation for good foot care for these residents starts early.

"We do a thorough, full-body assessment at the time of admission, including a foot assessment," she says. "We look for foot deformities and assess the condition of the toes and toenails, making sure there is no infection in or around the nail bed. We also note if the feet are excessively dry or have calluses, swelling, redness, bruising, ulcerations or pre-ulcerations. If we find any of these things, we notify the attending physician and obtain orders for a podiatrist, so that treatment can be started right away and problems avoided."

DeCamp points out that, once admitted, residents with diabetes have the condition of their feet monitored by the caregivers who bathe them, each time they are bathed. She says that to try to follow the guidelines for community-dwelling diabetics--such as daily foot inspection-simply isn't practical or necessary in the nursing home setting.

"People in long-term care facilities are in a protective environment," explains DeCamp. "They're less vulnerable to trauma to their feet, such as burning them while walking on a hot beach or experiencing a puncture wound from stepping on a nail while walking around outside without shoes. Therefore, the regular foot monitoring we provide has been more than sufficient to prevent problems."

She notes that in order to provide every diabetic resident with daily foot washing and inspection would require a complete re-evaluation of staffing patterns and, most likely, an increase in the number of staff.

"We've never had a problem with this level of care," DeCamp says. "If we were to suddenly find ourselves with a large number of residents at especially high risk of developing diabetic foot ulcers, perhaps we'd have to reassess our approach.

"Educating staff is a high priority when you're trying to deliver quality care," she says, "and it helps a great deal to have a good relationship with your podiatrist. When ours is here treating residents, she is also providing continuous, ongoing education to our CNAs, which helps them realize that they are an integral part of the care team. She's great with our staff."

DeCamp adds, "Foot care takes an interdisciplinary approach, just as any other type of care does. In addition to our staff podiatrist--who reviews any concerns we have about potential complications, makes regular visits to our facility and is on call to help with any problems that arise--we also have a consultant dietitian and certified dietary manager who are involved. They do a total nutritional review shortly after admission, and then they continue to monitor residents' diets. The dietitian also reviews the monthly reports of pressure sores, to see what adjustments these and other residents might need.

"Another essential part of the team is rehab, who determine whether a diabetic resident needs prosthetic devices or special shoes.

"The important thing to keep in mind in all this is that elderly residents with diabetes or peripheral neuropathy or vascular disease are always at high risk of developing foot complications. We have to make sure staff are trained and skilled in performing the regular assessments of residents, so that we can prevent problems."

Jean DeCamp, RNC, is director of nursing at Village North Health Center in St. Louis. She has been a DON for 18 years and has been involved with long-term care for 24 years.

COPYRIGHT 2001 Medquest Communications, LLC
COPYRIGHT 2002 Gale Group

A great opportunity--foot care nursing.

A great opportunity:

Foot care nursing.

by Mitchell, Kim

Nevada RNformation • Nov, 2007 • Nursing Practice--News You Can Use

Article Tools

When people cannot get their shoe on, especially seniors, they don't get out, they don't exercise, they eventually get isolated. To me it is an extension of good health care and nurses are all about good health; that is the major reason I became a foot care nurse.

In 1994 I was working for St. Mary's Home Care when the director asked me," how would you like to do foot care?" That question brought a range of reactions from," well maybe" to " I don't do feet!" I was curious so I took the program designed by Dr. Chambers & took the required test. That's where it all began for me. I did foot care for home care & then had an opportunity to take the program to St. Mary's Silver Connection; where the Happy Feet program was created. The program filled a need in the senior community & was associated with Dr. Karrasch's free foot clinic that he provided to seniors there. In Reno we have a great group of supportive doctors for this program.

I left the Reno area in 1998, but the programs remained with other great nurses doing foot care. Sadly, St. Mary's ended the programs, but foot care continued to be performed by some independent practitioners: Foot Care by Petra Niederberger, Nurse's Touch by Kay Hubley, & Happy Feet II by Renate Lawrence are some of those nurses. In 2006 I started the Step by Step program.

When Shelly Taylor brought her 3 day program to Nevada it was a great learning experience. It provided reinforcement that foot care is a much needed service & nurses are the best people to provide it. It encouraged networking between those of us who do foot care & those who are interested in starting. Getting certified to do foot care was another benefit & did I mention, we had a great time!

As the senior population increases, as people develop diabetes, arthritis, and other health challenges this service will become even more important and even critical in preventing amputations with quality foot care. Nurses are the perfect people to assess, provide good care, & educate about staying healthy. Doing foot care gives nurses the opportunity & the time to do just that.

So my question to those of you reading this is "How would YOU like to do foot care?" It is a great & rewarding job! Become certified! Questions: cashfur@yahoo.com

Kim Mitchell RN

Diabetes and your feet

Foot care: A step toward good health

Foot problems are very common in people with diabetes and can lead to serious complications. This fact sheet provides basic information about how diabetes affects your feet and what you can do to keep your feet healthy. Contact the Canadian Diabetes Association for additional resources.

Diabetes and your feet

Diabetes affects the circulation and immune systems, which in turn impairs the body's ability to heal itself. Over time, diabetes can damage sensory nerves (this is known as "neuropathy"), especially in the hands and feet. As a result, people with diabetes are less likely to feel a foot injury, such as a blister or cut. Unnoticed and untreated, even small foot injuries can quickly become infected, potentially leading to serious complications.

Daily foot care

As always, prevention is the best medicine. A good daily foot care regimen will help keep your feet healthy.

Start by assembling a foot care kit containing nail clippers, nail file, lotion, a pumice stone and a non-breakable hand mirror. Having everything you need in one place makes it easier to follow this foot care routine every day:

1. Wash your feet in warm (not hot) water, using a mild soap. Don't soak your feet, as this can dry your skin.
2. While your feet are still wet, use a pumice stone to keep calluses under control.
3. Dry your feet carefully, especially between your toes.
4. Thoroughly check your feet and between your toes to make sure there are no cuts, cracks, ingrown toenails, blisters, etc. Use a hand mirror to see the bottom of your feet, or ask someone else to check them for you.
5. Clean cuts or scratches with mild soap and water, and cover with a dry dressing suitable for sensitive skin.
6. Trim your toenails straight across and file any sharp edges. Don't cut the nails too short.
7. Apply an unperfumed lotion to your heels and soles. Wipe off excess lotion that is not absorbed. Don't put lotion between your toes, as the excessive moisture can promote infection.
8. Wear fresh clean socks and well-fitting shoes every day. Whenever possible, wear white socks – if you have a cut or sore, the drainage will be easy to see.

Best advice

Do wear well-fitting shoes. They should be supportive, have low heels (less than 5 cm high) and should not rub or pinch. Shop at a reputable store with knowledgeable staff who can professional fit your shoes. Do wear socks at night if your feet get cold. Do elevate your feet when you are sitting. Do wiggle your toes and move your ankles around for a few minutes several times a day to improve blood flow in your feet and legs. Do exercise regularly to improve circulation. Do inspect your feet daily and in particular feel for skin temperature differences between your feet.

Don't wear high heels, pointed-toe shoes, sandals (open toe or open heel) or worn-out shoes. Don't wear anything tight around your legs, such as tight socks or knee-highs. Don't ever go barefoot, even indoors. Consider buying a pair of well-fitting shoes that are just for indoors. Don't put hot water bottles or heating pads on your feet. Don't cross your legs for long periods of time. Don't smoke. Smoking decreases circulation and healing, and significantly increases the risks of amputation.

When to see your doctor

If you have any swelling, warmth, redness or pain in your legs or feet, see your doctor right away.

If you have any corns (thick or hard skin on toes), calluses (thick skin on bottom of feet), in-grown toenails, warts or slivers, have them treated by your doctor or a foot care specialist (such as a podiatrist, chiropodist or experienced foot care nurse). Do not try to treat them yourself.

Have your bare feet checked by your doctor at least once a year. In addition, ask your doctor to screen you for neuropathy and loss of circulation at least once a year.

Take your socks off at every diabetes-related visit to your doctor and ask him or her to inspect your feet.