A number of years ago I began to work in the hospital and was shocked at how many folks were in for foot wound debridement and amputations. Even though I have some patients in the outpatient world that have neuropathy and need medications to help them tolerate pain, and some who have lost a foot to an amputation, I was totally unprepared for the number of foot and below the knee amputations that were performed on a regular basis. And unfortunately, patients with excellent blood glucose management now, but poor control earlier in their lives with diabetes, were not immune.
Approximately 50% of patients with diabetes will develop neuropathy at some point in their lifetime, most experiencing peripheral neuropathy involving the lower extremities. Those with poor diabetes management are at highest risk.
As diabetes educators, it is important for us to include education about self-foot examinations in most of our education sessions. Visually inspecting feet should be done at most visits, with a thorough foot exam at least annually by a trained individual, be it a diabetes educator or medical provider. The annual exam should include visual examination of the feet as well as sensory assessment. In cases when problems are detected, referring to a podiatrist with a strong understanding of diabetes is a must. The new 3rd edition of The Art and Science of Diabetes Self-Management Education Desk Reference is a wonderful resource for providing information on frequency of screenings, explaining the visual foot assessment, and providing information on what should be included in a comprehensive foot exam.
In addition to screenings, prevention of complications starts with teaching patients to pay attention to their feet. Ask your patient if they wash their feet regularly? Dry between their toes? Take off their socks each night and check for any sores, dry or red areas. If the individual cannot see the bottoms of their feet, encourage the use of a mirror. Have a sample of one in your office and help them look at their feet. Remind them of the importance prompt medical attention if their assessment reveals any question about the health of their feet.
I can remember many years ago attending a session at an American Diabetes Association Annual Meeting, where the presenter showed slides of foot and leg complications of diabetes due to poor management. I was young and so surprised that something so destructive could be occurring, often undetected.
I am now no longer surprised, but saddened. Prevention is really the answer, and teaching patient to care and examine their feet, along with managing their blood glucose values, can go a long way to help reduce the risks of irreparable damage.