Opinion
Would you be able to spot a foot attack? Being aware of the early signs of this potentially serious problem in people with diabetes can help keep them out of hospital, says Jackie Watts
Daily observation People with high-risk feet should be cared for by a foot protection team or specialist podiatrist. They should be seen every one to three months and a personal foot care plan should be agreed and documented. Daily observation to spot early signs of emerging problems is also essential. Older people in residential or hospital settings may be unable to perform self-care and therefore rely on nurses and care staff to spot early signs of a foot attack. A foot attack may start as a simple tissue injury or small break in the skin and can quickly develop into a foot ulcer in someone at high risk. Injuries may appear as blisters, bruising or bleeding and may not be felt by the individual due to lost sensation. Lack of oxygen and nutrients due to peripheral vascular disease mean healing is impaired. Infection is common
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THERE ARE more than 100 diabetes-related amputations in the UK every week, and foot ulcers cause more admissions to hospital than any other diabetes complication. Up to one quarter of residents in UK care homes have diabetes and one of these people will be admitted to hospital every 25 minutes. These statistics indicate that older people with diabetes, particularly those in care homes or hospitals, are likely to be at high risk of developing a serious foot problem or ‘foot attack’. Although people with diabetes and their carers may be aware of the need for good foot care, knowing what action to take and when, if there is concern, may not always be so clear.
and progression to tissue necrosis and subsequent amputation can be rapid. As part of an overall diabetes annual review, a good quality foot check with a doctor, nurse or podiatrist should identify individual risk of a foot attack, which should be documented in the individual’s care plan. People are at high risk if they have a previous history of foot ulcers or previous amputation, or two or more of the following: neuropathy/loss of sensation, peripheral vascular disease/poor circulation, or deformity such as a bunion or claw toe.
A foot attack may start as a simple tissue injury or small break in the skin and can quickly develop into a foot ulcer in someone at high risk Nurses and carers can easily spot warning signs of a foot attack by being alert to patients who are feeling unwell, feet which are red, warm or swollen or where there is a break in the skin, bruising or signs of obvious pressure, or discharge on socks or stockings. In a high-risk patient these signs should prompt the nurse to contact the GP or foot protection team. Remember that patients may have peripheral neuropathy and may not feel pain, so their perception should not be used as a deciding factor. In the event of a foot attack, the patient will probably require antibiotics as well as wound care. Pressure relief is important and unnecessary standing or walking should be avoided. Older, frail patients, particularly those with dementia, will require support to prevent further injury, for example, where wandering and pacing is part of their usual behaviour pattern. Maximise healing Diabetes treatment may also be altered to maximise healing potential and carers need to be alert to further fluctuations in blood glucose, for example, to avoid potential hypoglycaemia, once infection has resolved. Good fitting footwear is essential and some people will need custom-made shoes or orthotics for ongoing pressure relief of the foot. Diabetes UK has produced a free booklet called How to Spot a Foot Attack, which aims to provide clear direction on what to look for and how to respond to any sign of a potentially serious problem in people who are at high risk. Jackie Watts is a clinical adviser for Diabetes UK
Find out more Order How to Spot a Foot Attack at: shop. diabetes.org.uk/go/red-card-foot-booklet
NURSING OLDER PEOPLE April 2014 | Volume 26 | Number 3 11 Downloaded from RCNi.com by ${individualUser.displayName} on Nov 21, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Would you be able to spot a foot attack? Being aware of the early signs of this potentially serious problem in people with diabetes can help keep them out of hospital, says Jackie Watts
Daily observation People with high-risk feet should be cared for by a foot protection team or specialist podiatrist. They should be seen every one to three months and a personal foot care plan should be agreed and documented. Daily observation to spot early signs of emerging problems is also essential. Older people in residential or hospital settings may be unable to perform self-care and therefore rely on nurses and care staff to spot early signs of a foot attack. A foot attack may start as a simple tissue injury or small break in the skin and can quickly develop into a foot ulcer in someone at high risk. Injuries may appear as blisters, bruising or bleeding and may not be felt by the individual due to lost sensation. Lack of oxygen and nutrients due to peripheral vascular disease mean healing is impaired. Infection is common
Getty
THERE ARE more than 100 diabetes-related amputations in the UK every week, and foot ulcers cause more admissions to hospital than any other diabetes complication. Up to one quarter of residents in UK care homes have diabetes and one of these people will be admitted to hospital every 25 minutes. These statistics indicate that older people with diabetes, particularly those in care homes or hospitals, are likely to be at high risk of developing a serious foot problem or ‘foot attack’. Although people with diabetes and their carers may be aware of the need for good foot care, knowing what action to take and when, if there is concern, may not always be so clear.
and progression to tissue necrosis and subsequent amputation can be rapid. As part of an overall diabetes annual review, a good quality foot check with a doctor, nurse or podiatrist should identify individual risk of a foot attack, which should be documented in the individual’s care plan. People are at high risk if they have a previous history of foot ulcers or previous amputation, or two or more of the following: neuropathy/loss of sensation, peripheral vascular disease/poor circulation, or deformity such as a bunion or claw toe.
A foot attack may start as a simple tissue injury or small break in the skin and can quickly develop into a foot ulcer in someone at high risk Nurses and carers can easily spot warning signs of a foot attack by being alert to patients who are feeling unwell, feet which are red, warm or swollen or where there is a break in the skin, bruising or signs of obvious pressure, or discharge on socks or stockings. In a high-risk patient these signs should prompt the nurse to contact the GP or foot protection team. Remember that patients may have peripheral neuropathy and may not feel pain, so their perception should not be used as a deciding factor. In the event of a foot attack, the patient will probably require antibiotics as well as wound care. Pressure relief is important and unnecessary standing or walking should be avoided. Older, frail patients, particularly those with dementia, will require support to prevent further injury, for example, where wandering and pacing is part of their usual behaviour pattern. Maximise healing Diabetes treatment may also be altered to maximise healing potential and carers need to be alert to further fluctuations in blood glucose, for example, to avoid potential hypoglycaemia, once infection has resolved. Good fitting footwear is essential and some people will need custom-made shoes or orthotics for ongoing pressure relief of the foot. Diabetes UK has produced a free booklet called How to Spot a Foot Attack, which aims to provide clear direction on what to look for and how to respond to any sign of a potentially serious problem in people who are at high risk. Jackie Watts is a clinical adviser for Diabetes UK
Find out more Order How to Spot a Foot Attack at: shop. diabetes.org.uk/go/red-card-foot-booklet
NURSING OLDER PEOPLE April 2014 | Volume 26 | Number 3 11 Downloaded from RCNi.com by ${individualUser.displayName} on Nov 21, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
