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Foot Care By: Dr. Hala Al-Khalidi Clinical pharmacy @ KAAU Tuesday, November 15th, 2005. Foot Care Proper foot care should begin at early age to develop healthy habits bone components mature until age ( F 14-16, M 15-21) Three groups: 1. Pediatrics congenital malformation( juvenile arthritis) 2. Adolesents OA 3. Geriatrics DM, RA, OA Causes of Foot Problems Harmful foot practices as Scraping/ cutting corn’s & Calluses Improper trimming of toe nails Opening blisters/ removing skin covers Improper use of hot water Potentially harmful home remidies (e.g. butter, crisco, clorox, windex, gasolin, karosene) Poor patient education/ awareness After years of body weight bearing feet tend to broaden, & flatten (F =30’s, M =40’s) Foot Problems Sore aching feet Ingrown toe nails Corns & Calluses Planter warts Fungal infections A blister is an area of raised skin with a watery liquid inside. Blisters form on hands and feet from rubbing and pressure, but they form a lot more quickly than calluses. You can get blisters on your feet the same day you wear uncomfortable or poor-fitting shoes. You can get blisters on your hands if you forget to wear protective gloves when you're using a hammer, a shovel, or even when you're riding a bike. Gel Callus Lined with gel that provides superior protection for sensitive toes. Digi-Cushions mold to the skin, insulating toes against shock and pressure Diabetes and foot care Because diabetes may keep you from feeling foot problems, it is very important to: look at your feet every day to check for things like cuts, sores, ingrown or infected toenails, dry cracked skin or swelling wear shoes that fit well so you don't get blisters, corns or bunions on your feet ask your doctor to check your feet at each visit Diabetes and foot care 25% of patents with DM may develop sever leg or foot problems are not just painful, but dangerous Diabetes can damage nerves. Patent might not feel hot, cold or pain in there feet. Little cuts or sores, if not cared for, can then become deeper and bigger sores ulcers. Diabetes and foot care This can be a very serious problem because diabetes can also cause poor blood flow in legs leading to poor sores healing. If ulcers become infected (20%)more hospital days then any infection, foot tissue starts to die because of poor or no blood flow (gangrene) DM pt. are 17 times more prone. More then 50% of foot amputations could have prevented through appropriate diabetes control, (amputate) toes, foot or leg, & poor pt. education. Diabetes and foot care One in two PWD’s >10yrs Will develop neuropathy = dec. sensitivity + dec. pt. awareness of minor trauma Continuous irritation ulcer forms within 24 hrs Ill-fitting shoes callus form inc. pressure on callus ischemia & ulceration only seen if bleeding/ Odor is noticed from the wound Diabetes and foot care Diabetic foot ulcerations PVD (are 20x more susptibale due to arterial insufficiency below the knee ischemia Uncontrolled DM LDL & HDL arterial plaque = worsening circulation Immunocompromised pt.s mobilization of leukocytes , phagocytic ability, & O2 radical production infection fight Perepheral circulation= clearance of metabolic waste, PH anaerobic infection @skin & nails Diabetes and foot care Tack’s & pins were removed from foot ulcers dec. sensation, & no daily inspections Counseling a PWD about foot ulcers for safety pt. should routinely see MD, & only superficial foot ulcers should be tx. With topical Abx. Cream, or ointments, with simple dressing Erythema, local infection, & swelling need oral Abx. For at least 10 days, change after C&S Reduce pt. weight off the foot, & a 10 min walk/day esp. if feet swollen or infected, cane/ wheelchair Diabetes and foot care A 70% of deep foot infections are polymicrobial & involve 3-5 MO Aerobes= Staph. Aureus, staph. Epidermidis, & streptococcus Sp., Anaerobes= bacteroides Sp., Peptococcus Sp., & Clostridium perfringens Gm(-ve) =E.Coli, proteus Sp., & Klebsiellas Limb-threatning infections tx. Abx. Combo.+ bedrest + incision, drainage, & debridement of foot ulcer Diabetic Patient Education “If you look at your feet everyday, they will stay attached to your ankles” Daily cleaning – drying (esp. between toe’s) carefully- prevent irritation & breaking of skin Moisturizers/ veg.oil, on skin not between toe nails to prevent bact./ fungal infection To soften toenails soak in warm-water + ½ tsp (Na borate) moister around toenails, file nails strait Rubbing feet upward toward the tip of toe’s Diabetic Patient Education Varicose veins rub feet but not the legs Elastic hosiery with tight top band, Crossing legs may close blood supply to the legs not recommended, circulation Take shoes off from time-time while traveling place a pillow at the end of the bed Avoid heating pads/ mod. Heat can injure the skin with poor circulation Treatment of Corns & Calluses in Diabetic Foot Friction can form corns, & calluses, proper foot wear is a must, stretching foot & legs a few times a day, no high heels, are preventives Soaking feet x15min – remove access tissue with towel- file or medical sand paper – do not irritate(no razor blade, or knives serious infection & could be life threatning, uncontrolled see MD Do not use Salisylic acid (OTC), can irritate skin Skin Disorders Self-treatment measures should be supervised by a physician Reddness, cuts, blisters, pain, or swelling should se a physician To prevent ulcers, further infections, & gangrenes Athletes foot= is peeling, +/- itching around, & between toe’s, infected by Tinea Unguium Infection of the toe nail characteristic by brittle discolored nail beds Skin Disorders PWD’s should not use strong antiseptics as tincture of iodine can dry & irritate skin Gauze bandage, Cellulose tape (scotch tape), if needed to cover the wound, if adhesive tape skin soggy & MO & infection, plus irritate skin when removed Poor Circulation Symptoms= cold, numbness, tingling, burning, or fatigue Discolored, dry skin, absence of hair on leg’s, & feet, cramping, & tingling of leg muscles Patients complaining of aching calves during walking, need to hang feet over bed see MD Possible blockage (clot) of circulation coldness in one foot, one lower leg or foot will appear larger then the other, with waxy appearance, no hair growth, & thick nails, consult MD Poor Circulation Daily foot bath- dry patting- foot cream (retian moister) softer brittle toe nails for clipping & filing Keep foot warm with moderate exercise every day Arthritis OA = non-inflammatory, DJD, occurs 1ry in older population, & a 2ry complication in athletics injury in late teens/ early twenties Hallux limitus or rigidus of the big toe, stiffness, & spur formation (metatarsophalangeal joint) difficulty in fitting shoes Padding shoes + insoles protect feet from hard surfacw Regular examination by podiatrist Ingrown Toenails A nail presses into the soft tissue of nail groove of the toe pain, swelling, & ulceration Incorrect trimming of toe nails, & to correct cut strait across, with out tapering corners Opportunistic resident foot bact.+ ingrown nail = skin infection FDA recommendation; Na sulfide soften keratin in nails, & tannic acid hardens, & shrinks skin surrounding the nail, by placing a medicated cotton on the side of the nail, no > 7 days Foot toe cap temporarily Tips Some tips for buying shoes that protect your foot health, home & out leave on & check Size Have both of your feet measured every time you buy shoes only leather soft, since your feet may not be the same size, choose shoes that are 1/2 inch longer than your longest toe. Blisters, ulcers and bunions are often linked to shoes that are too small, Buy shoes late in the day as feet tend to swell (edema). Tips Because diabetes may keep you from feeling foot problems, it is very important to: look at your feet every day to check for things like cuts, sores, ingrown or infected toenails, dry cracked skin or swelling wear shoes that fit well so you don't get blisters, corns or bunions on your feet ask your doctor to check your feet at each visit
