2008 Clinical Practice Guidelines - Canadian Diabetes Association

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2008 CLINICAL PRACTICE GUIDELINES S200 Appendix 5 Diabetes and Foot Care:A Patient’s Checklist Many people with diabetes have problems with their feet. Ask your doctor to explain your risk factors for foot problems.You can prevent serious foot problems by following these basic guidelines. DO… DON’T… …check your feet every day for cuts, cracks, bruises, blisters, sores, infections or unusual markings. …use a mirror to see the bottom of your feet if you can’t lift them up. …check the colour of your legs and feet. If there is swelling, warmth or redness or if you have pain, see your doctor or foot specialist right away. … clean a cut or scratch with a mild soap and water and cover with a dry dressing for sensitive skin. …trim your nails straight across. …wash and dry your feet every day, especially between the toes. …apply a good skin lotion every day on your heels and soles. Wipe off any excess lotion. …change your socks every day. …always wear a good supportive shoe. …always wear professionally fitted shoes from a reputable store. Professionally fitted orthotics may help. …choose shoes with low heels (under 5 cm high). …buy shoes in the late afternoon (since your feet swell slightly by then). …avoid extreme cold and heat (including the sun). …exercise regularly. …see a foot care specialist if you need advice or treatment. …cut your own corns or calluses. …treat your own in-growing toenails or slivers with a razor or scissors. See your doctor or foot care specialist. …use over-the-counter medications to treat corns and warts. They are dangerous for people with diabetes. …apply heat to your feet with a hot water bottle or electric blanket.You could burn your feet without realizing it. …soak your feet. …take very hot baths. …use lotion between your toes. …walk barefoot inside or outside. …wear tight socks, garters or elastics, or knee highs. ….wear over-the-counter insoles – they can cause blisters if they are not right for your feet. …sit for long periods of time. …smoke. Adapted with permission from: Casella A. Feeling well…diabetes and foot care, a patient’s checklist. Knowing Diabetes. © Diabetes Hamilton, 2002
Appendix 6 Diabetic Foot Ulcers: Essentials of Management 1. Assess underlying cause(s): neuropathy and/or ischemia. REFERENCES 1. Lavery LA, Baranoski S,Ayello EA. Options for off-loading the diabetic foot. Adv Skin Wound Care. 2004;17:181-186. 2. Lipsky BA, Berendt AR, Deery HG, et al; for the Infectious Diseases Society of America. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2004;39:885-910. 3. Frykberg RG, Zgonis T,Armstrong DG, et al; for the American 2008 CLINICAL PRACTICE GUIDELINES 2. Ulcers should be probed with a blunt-tipped instrument to detect sinus tracks or palpable bone suggestive of deep infections. 3. Plantar-surface ulcers require pressure relief. Individuals with plantar-surface foot ulcers should be non-weight-bearing as much as possible and utilize off-loading footwear or appliances (1). 4. Clinically noninfected ulcers do not routinely require cultures or antibiotics (2). 5. More serious infections in chronic foot ulcers tend to be polymicrobial and typically require empiric use of broad spectrum systemic antibiotics as soon as possible. Antibiotics can be subsequently tailored according to culture and sensitivity results. Cultures obtained by curettage or biopsy tend to be more reliable than surface swabs (3). 6.Wound bed preparation involves debridement of necrotic tissue (neuropathic wounds and noncritical ischemic wounds only) and maintenance of adequate moist wound environment with appropriate wound dressings. Hydrogels are used to increase wound bed moisture in dry or minimally draining neuropathic ulcers. Dressings that provide therapeutic levels of ionic silver or iodine may reduce critical degrees of wound bacterial colonization (4). 7. Comorbidities need to be managed (e.g. hyperglycemia). 8. Refer to a specialized wound clinic where available. College of Foot and Ankle Surgeons. Diabetic foot disorders.A clinical practice guideline (2006 revision). J Foot Ankle Surg. 2006;45(5 suppl):S1-S66. 4. Schultz GS, Barillo DJ, Mozingo DW, et al; for the Wound Bed Advisory Members.Wound bed preparation and a brief history of TIME. Int Wound J. 2004;1:19-32. S201 APPENDICES
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2008 Clinical Practice Guidelines - Canadian Diabetes Association

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