More Diabetic Foot Disasters

Two more diabetic foot disasters arrived in the practice and at my Hospital clinic this weekend. Another hot water bottle burn, plus a corn paste induced abscess.

Loss of sensation and lack of foot health education contributed to the elderly lady with Type 2 diabetes burning her left little toe and the lower part of her calf, plus blistering her right big toe. The lower calf is about 2mm deep and the blisters were still covering intact skin.

If you are in any way involved with people with diabetes this winter please warn them of the dangers of hot water bottles, heating pads etc. Remind them of the tips I put out recently for winter foot care.

When diabetes causes loss of sensation in the lower leg then putting hot objects like hot water bottles next to the skin can lead to serious damage.

Medicated corn plasters and pastes have been around for years and are usually used by desperate people who don’t know that a podiatrist can give them relief from their painful corns and calluses.

Sadly my patient is also a Type 2 diabetic, but without complications and therefore was in great pain.

I drained the abscess, applied appropriate dressings and prescribed antibiotics. This lady is booked off work for 3 days plus the weekend and I will see her again on Thursday.

That’s a big penalty in lost working time for a lady who was simply trying to take care of her feet but did not understand the value of taking professional advice until it was too late.

So who is to blame for these disasters? If the patients concerned didn’t know, then I am for not getting the good foot health message across to enough people. On the other hand the patients did know who to come to for help.

The Diabetic and the barley bag – part 2

Loss of sensation and reduced blood flow to the lower limbs and feet are a well known complication of diabetes. As winter progresses, people with diabetes are at increased risk from problems associated with damage caused by trying to keep the feet warm. The lady I wrote about on May 7 is still at high risk.

Fortunately she is sticking to her care routine and the toe has stabilised. The blistered skin dried and formed a hard crust – actually this is a dry gangrenous crust – has formed over the centre of the wound, but the edges are clean and pink. The primary key to a successful outcome is control of blood sugar and that is good. Secondary is the quality of wound care and hopefully we are up to standard.

The biggest problem we have when treating diabetic foot ulcers is to keep weight off, called off-loading. Naturally, this is very difficult for a patient who knows they have a foot ulcer, but doesn’t feel any pain. Remember, pain stops us from doing further damage to an injured body part.

Here are a few WINTER FOOT TIPS FOR PEOPLE WITH DIABETES.(It’s winter in the southern hemisphere).

Keep up the daily washing and drying -especially drying

Keep up/start a daily routine of gently massaging moisturiser into your legs and feet

Remember that your shoes may become tighter because you are wearing socks and closed shoes

When you take off your shoes, check your feet for tell-tale red marks – this means dangerous pressure

Check that your shoes do fit, you possibly haven’t worn then for some months

Thicker-soled shoes will keep your feet warmer

Don’t let your boots squeeze your calf muscles and reduce circulation

Keep your feet warm at night – wear socks. NOT nylon, but cotton or wool or mixtures

Heat your bed BEFORE you get in and turn off electric blankets and heating pads. Remove hot water bottles

Try to avoid sitting in draughts – difficult, because we have houses that are designed for coolness

Wrap a blanket around your legs and feet if you are in a cold room

Never sit too close to any fire or heater – (people have fallen asleep and burnt their legs & feet)

Try to keep your excercise routine going, even though it’s darker morning and evening

p.s. Cape Mohair make excellent socks

Diabetic Foot Dangers – ‘the barley bag’

As winter approaches the southern hemisphere, the risks of damage to the feet of people with diabetes increase. The weather turned nasty in Johannesburg last weekend – wet and cold – as a result I saw my first Autumn diabetic foot disaster yesterday. A burn on the big toe of a lady who went to bed with her ‘barley bag’. It doesn’t have to be barley, rice, lentils, in fact anything that can be heated in the microwave.

After heating the bag in the microwave this lady put it into the bed to warm it up. Her big mistake was, that when she went to bed she didn’t remove the bag from the bed. During the night her foot came to rest on the bag and burned her big toe, leaving a blister along the whole length it.

When she saw me, the blister had broken and the base was infected. So now she is under treatment for a foot ulcer. The sad thing is that I spent months in 2007 succesfully healing an ulcer on this lady’s other big toe.

So what’s the message? You could say the ulcer is a result of a failure of diabetic foot health education – we didn’t get the right message across – but it does highlight the fact that everybody involved in diabetic foot care has to be constantly alert to potential dangers. In this case we have a high risk patient with peripheral vascular disease and diminished sensation who made a mistake with serious consequences. So what are the key messages for winter protection for the diabetic foot?

• wash and dry your feet thoroughly
• remove any heating bags or hot water bottles before getting into bed
• turn off any heating pads or electric blankets when you get into bed
• make sure your winter socks are not too tight on your feet and around your legs
• take care that you can wriggle your toes in your shoes when you have thicker socks on
• remember that a thicker-soled shoe will keep your feet warmer
• if you live in a winter rainfall area, dry your feet as soon as possible after they get wet
• try wearing loose-fitting cotton or woollen socks in bed
• if your feet swell during the day, remember to allow for it when you wear your winter shoes or boots
• STOP SMOKING!

Take care of your pair and see a podiatrist