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Basic Footcare for high risk feet

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Basic Footcare for high risk feet

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    1. Basic Footcare for high risk feet A lecture for NHS staff Tutor: Andy Neve Specialist Podiatrist E-mail: andyneve@chiropods.co.uk Website: www.chiropods.co.uk

    2. Foot Function? Locomotion Stability Cultural Aesthetic Foot Size: Male: Large Feet = attractive Female: Small Feet = attractive Foot Shape: Chinese Foot Binding

    3. Chinese Foot Binding or the Golden Lotus

    4. Are western societies any less obsessed with changing foot shapes?

    5. Footwear Function Protection Weather, environment. Comfort Warmth, ventilation Functional for Activity Walking, Running, Sports, Social

    6. How the foot works Normal gait: Controlled falling Shifting centre of gravity forward Feet and leg moves forward to prevent fall. Swing Phase: Toe off; dorsiflexion of ankle; Supinate Stance Phase: Heel Strike; Mid Stance; Pronate

    7. How Age affects function of feet Age related or Medical problems can lead to: Ischaemia Neuropathy Foot Deformity Poor Tissue Viability Poor Gait

    8. Diabetic Foot Problems Foot ulceration – 'diabetic foot' – is the commonest reason for people with diabetes to be admitted to hospital in the UK. (Young MJ et al 1994) Diabetic Foot problems take up more bed days than all the other complications put together (Waugh NR 1988) According to one widely cited study, people with diabetes are 15 times more likely to need amputation than people without the condition. (Bild DE et al 1989)

    11. What to look for? Check toenails, toes, in between toes Ball of the feet and heels Look for Blisters, fissures, wounds or ulcers Anything that may cause an opportunity for a bacterial infection

    16. Example of hidden infection/ulcer

    17. Referring patients to specialists Non healing wounds Medical staff: Antibiotics, vascular team Nursing staff: Dressing advice Tissue Viability Nurses: New Ideas Diabetes? Diabetes Specialist Nurses Specialist Podiatrists Corns, Callus, Toenail Problems Hospital Podiatrists/Chiropodists while on ward Community Podiatrists/Chiropodists on discharge

    18. Sharp debridement by Specialist Diabetes Podiatrist

    19. What to do about foot wounds? Establish cause if possible (etiology) Avoid cause if possible Antibiotics and Antimicrobial dressings if wound is infected Iodine or silver based If wound is sloughy use chemical debriders until base of wound is healthy red/pink granulation tissue Hydrocolloid like Aquacel to sloughy area only Intrasite or Purilon Gel

    20. Example of burn from a radiant heater

    21. NHS referral Criteria for Podiatry/Chiropody Priority are Foot Problems associated with medical conditions: Ischaemia Diabetes Rheumatoid Arthritis Neuropathy/Neurological conditions Secondary are general patients with foot problems such as specific nail conditions; corns or callus exacerbated by age related problems Not “social” nail cutting

    22. Products to avoid Corn and callus plasters/creams/solns Corn Knives Cheese grater type callus removers Contain Acids Can cause Ulceration Non sterile blade Can cause infections Too abrasive Can cause wounds

    23. Affects of Corn Plaster

    24. Products that can be safe Pumice Stones Emollients Foot Spas Use wet and with soap Used daily such as Aqueous Cream BP Check Temp. Use for few minutes only Beware vibration mode Avoid ones with infra red lamp

    25. Footwear Advice Good Shoe? Good Fit Length Width (Ball & Toes) Depth Stable Supportive? Smooth internal seams Fastenings Bad Shoe? Poor Fit Too long or short Too narrow Too shallow Unstable Not Supportive? Rough internal seams No Fastenings

    26. Testing the fit of Shoes Template Method: draw around foot onto card and cut out the outline and slide template into shoe to assess shoe fit Inner sole method Remove inner sole from shoe and stand on inner sole to assess overlap Main areas of fit: Topline, Counter, Facings, Vamp, crease lines

    27. Check shoe from the side

    28. Heel design Heels should be as broad as the foot to aid stability Increased heel height adds pressure to the forefoot and increases the lumbar curvature of the spine to stay upright. Increased heel height reduces the need for a propulsive gait with dynamic foot function

    29. Heel wear

    30. Throat (topline) Entry point of foot into shoe Ease of entry is affected by style Fastening must be functional and adjustable Adjustment allows for swelling

    31. Distortion of the upper

    32. Objective assessment Close fit at heel No gaping at topline No local tight spots Broad heel of suitable height Adequate width & depth for 1st MP joint Functional fastening

    33. Remember High Risk Feet can deteriorate rapidly

    34. 3 weeks later after moist wound healing techniques applied

    35. Pt. Hospitalised for infection and BKA

    36. Summary Check skin of the feet for wounds Treat any open wounds Check footwear and give advice to patient, carers and family Refer on to specialists when necessary High Risk feet can deteriorate rapidly Always check both feet even if pt says its only my “left” one.

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