1.27 Diabetic foot Flashcards
Why no heels on a diabetic shoe?
- increased pressure directly on calcaneus
- changes angle of heel and puts force on toe box
What is the problem with most shoes for diabetics? How do diabetic shoes combat this problem?
- have seams in toe box, which creates friction or rubbing point
- can create a wound
- diabetic toe box is usually domed and a continuous piece of fabric
Sole of a diabetic shoe
usually more cushioned for shock absorption
Optimal time to go get diabetic shoes
midday: don’t want to go when there’s too much or too little swelling
- want a snug fit with no heel pistoning
heel pistoning
heep rising and hitting up on the back of the heel counter
diabetics and sandals
- thong sandals put a lot of pressure between big and second toe
- have to squeeze to keep it on the foot
diabetics and slippers
- no arch or any other support
- their arch will be lost eventually as is, don’t want to mak e it worse
What must be done every time a diabetic puts shoes on?
- check inside EVERY time
- stuff gets in and a diabetic won’t feel it
When should a diabetic wear shoes?
all the time, anything on the ground can create a wound
What type of socks should diabetics wear?
- cotton
- white (to see blood)
- seamless if possible
diabetics and sock changing
- someone who sweats a lot or works in boot should change socks throughout the day
sock fitting
- make sure not too tight
- shouldn’t create a pattern of the sock on the foot
foot checks: how often?
once or twice a day
What does a diabetic need for foot checks?
- flexibility
- vision
- maybe a mirror
toenail maintenance for diabetics
- clip straight across (avoid ingrowns)
- shouldn’t take off too much
- TOENAIL CLIPPERS NEED TO BE CLEANED
bathing: temp
- water temp check
- can turn water heater down so it can’t make water as hot
bathing: getting out of the bath
- dry off completely, even between toes
- last thing they need is residual water and macerated tissue
bathing: lotion
- small amount of lotion on the foot
- not between toes
evaluating a diabetic patient with an ulcer: what to measure
- sensation
- pain
- blood supply/warmth
- location
- swelling (figure 8, circumferential, bilateral comp)
- calluses
- toenails
- strength/ROM
- navicular drop
What correlates with a loss of strength and ROM in diabetics?
increased risk of falls
Aside from measurements, what should be asked of a diabetic patient with an ulcer?
- Are they taking care of their feet? (Shoes, socks, foot care)
- blood sugars
sensory test types for diabetics
- Semmes Weinstein monofilament test
- vibratory
What do we consider protective sensation on a Semmes Weinstein test?
5.07
What does 5.07 mean?
10g pressure
