Scenario

My receptionist came to me regarding a call she received from the mother of a 12 year old boy. He was recently diagnosed as being diabetic, and his general practitioner thought it best that in the early stages, he sees a podiatrist to have a proper understanding of how to care for his feet. I was impressed by both the doctor’s recommendation, and the mother’s follow through. It highlighted an area that is sorely needed amongst certain groupings of patients. Equally, vascular and neurological patients, should be sent by their general practitioners and specialists, to see podiatry regarding proper care guidelines.

As a health provider, we should be placing a large degree of care in the hands of the patient. Health promotion and combined patient/provider care, is critical to spotting problems early in a patient. During an initial consultation, the patient along with their parent/guardian, are asked a number of questions regarding their medical history and lifestyle. These factors build a picture, and aid in effective care or treatment as the case may be.

Diabetic Annual Review

Doing a Diabetic Annual Review serves to inform of issues arising. It also educates the patient in their role of: preventing diabetic foot problems/injury, and foot care. It is the Podiatrist’s responsibility to detect any changes in skin and foot sensation, foot care and dressing. It is necessary for all diabetic patients, especially patients at risk for foot ulcers, to be familiar with the basics of foot care. Several studies suggest that patient education about foot care is effective in the prevention of diabetic foot ulcers. Podiatrists can teach patients how to perform a physical examination, and take care of their feet on a daily basis. For instance: encouraging patients to carry out a series of simple rules to help prevent foot ulcers, or recurrence; checking their shoes before wearing; keeping feet clean; and continuing care of the skin and nails. Training about choosing the right shoes is essential too.

Important Tips/ Maintenance

Routines

• Examine feet daily for discolouration, redness, swelling, skin cracks, blisters, cuts, soreness, cramping, pain, burning or numbness.
• Practise good foot hygiene (daily washing, followed by careful drying, especially between the toes).
• Ensure water temperature control, before washing your feet.
• Walk frequently, and be more active. Speak to your GP or Podiatrist about the proper amount of exercise.
• Trim toenails when needed, straight across, without cutting them too short. File the edges with an emery board or nail file.
• Apply a thin coat of lotion when moisturising the feet, and always avoid the area between the toes.
• Visit a Podiatrist once or twice a year for a thorough exam.

 Footwear

• Never walk barefoot, even on the beach. Wear shoes with socks.
• Wear comfortable shoes that fit well and protect the feet.
• Choose shoes that are the precise size. The best time for buying shoes is in the afternoon. Having properly fitting shoes will decrease the risk of complications.
• Check inside shoes before wearing them. Make sure the lining is smooth, and there are no objects inside.

Prevention

• Avoid extreme temperatures to the soles of your feet. Protect them from hot/cold, and don’t put feet into hot water. Always test the water before putting your feet in it, just as would be done before bathing a baby.
• Avoid crossing legs. When seated, wiggle toes and move feet around. Elevate the feet when sitting, if there is swelling of the feet and ankles.
• Seek the assistance of a podiatrist if corns, calluses, ingrown nails or other foot care related issues develop.
• Take care of your diabetes, it’s very important. Work with your healthcare team to keep your blood glucose within target range, and keep your HbA1c (a 3-month glucose test), within normal limits.

All these tasks must be adhered to, for proper maintenance. Compliance reduces the risk of certain issues occurring, or retards the process. While your child may be young, it is important to put their care in their hands from early, of course assisted by you.

Tribute

At the point last Monday’s article was sent, it wasn’t yet known that my editor, the great Deborah John was no longer with us. A St. Francois Girl, which makes me proud, she provided the avenue for me, an old girl too, to blossom. I expressed my gratitude to her for the opportunity to develop via this column, on the first occasion we met face to face. Thanks to her, I meet many persons who would share that were it not for the Express, they would not know what to do regarding foot care. A prominent figure in society said to me mere months ago, if you only know the impact this article makes on persons, especially those with diabetes. It is because of you, Ms. John, that this has been made possible; and again, though no longer here, I thank you!

Your feet mirror your general health . . . cherish them!