Foot ulcers are a major cause of foot and leg amputation in patients with diabetes. Yet, almost half of these amputations could be prevented by using a foot ulcer prevention plan.Before developing such a plan, explain to your patient the role that glucose control plays in preventing and healing foot ulcers. If your patient doesn’t have a foot ulcer, tell her that consistently high blood glucose levels increase her risk of developing one. If your patient already has a foot ulcer, tell her that poor glucose control hinders recovery and increases the risk of a recurrence.
Assessing The Patient
Begin by assessing your patient’s feet for abnormalities such as corns or bunions, which increase the risk of ulceration. Ask her how she cares for her feet.
Next, assess your patient for risk factors. If she has a history of diabetic neuropathy or peripheral vascular disease, she’s at greatest risk for developing a foot ulcer.
Unfortunately, the development of a foot ulcer may be the first sign that your patient has neuropathy or peripheral vascular disease.
Implementing The Plan
If your patient has no history of neuropathy or peripheral vascular disease and her foot assessment reveals no abnormalities, focus on correcting any misconceptions she may have about foot care. Then, instruct her in a daily foot care routine, which should include keeping her feet clean and dry, examining her feet for blisters, and wearing comfortable shoes. Also, advise your patient to have her feet examined by a physician at least once a year.
If your patient has calluses or corns, teach her how to manage the condition with an emery board, callus file, or pumice stone. Tell her that cutting calluses or corns off her feet or using an over-thecounter medicated pad to treat them may cause an ulcer to form. If your patient’s calluses or corns are caused by abnormally high or low arches, refer her to a specialist. Other abnormalities, such as hammer toes and metatarsal deformities, may require special shoes, regular care by a podiatrist, or surgical repair of the deformity.
If your patient already has a foot ulcer, your plan of care will include treating the ulcer and determining what caused it. Depending on the type of ulcer and its location, treatment may include the following:
- removal of the cause (for example, poor-fitting shoes)
- a restriction on weight-bearing activities, if the ulcer is on the plantar of the foot
- wound care to heal the ulcer
- infection control, including antibiotic therapy
- follow-up care.
To help prevent another ulcer, you should also review your patient’s knowledge and her compliance with routine foot care.