Foot care for patients with diabetes
Diabetic foot disease is usually associated with peripheral arterial disease and distal symmetrical polyneuropathy (peripheral neuropathy), which often coexist in patients with diabetes. Other risk factors include previous amputation or ulceration, abnormal foot structure, and poor vision or mobility.
All patients with diabetes should practice good general foot care. For patients with peripheral arterial disease, loss of sensation or foot abnormalities, daily foot care is essential to prevent complications such as ulceration, infection and, in extreme cases, extensive necrosis (gangrene) of the toes and feet. For comprehensive patient information on foot care for patients with diabetes, including a daily foot care checklist, see the Diabetes Feet Australia website. For comprehensive evidence-based guidelines on prevention of foot ulceration, see the Diabetes Feet Australia Prevention guideline.
To help prevent foot problems, advise patients with diabetes about the risks and causes of foot problems, and the importance of:
- wearing well-fitting footwear
- optimising the glycaemic profile and managing risk factors for peripheral arterial disease (eg tobacco smoking, elevated blood pressure, dyslipidaemia)
- regular podiatry review
- seeking specialist assistance at the first sign of foot problems.
Long-term management by a podiatrist is advisable for patients with diabetes who have risk factors for diabetic foot disease. These patients should perform daily checks of their feet for blisters, skin breaks and maceration.
Ideally, all patients with a diabetic foot ulcer should be managed by, or in consultation with, a multidisciplinary high-risk foot-care team. Cornerstones of management are:
- limb arterial revascularisation where indicated
- appropriate debridement and dressings (see Wound dressings)
- pressure offloading (see Interventions for high-risk foot wounds)
- antibiotic treatment for infected wounds (see Diabetic foot infection).
Consider immediate referral to hospital for assessment and management if the patient has:
- ischaemia (absence of foot pulses)
- infection or extensive necrosis
- suspected Charcot arthropathy (eg unilateral; red, hot, swollen foot).