It is estimated that up to 25% of all diabetics will develop a diabetic foot ulcer (1)
One of the cruelties of Diabetes Mellitus is that the people who are at most risk are often hurt the worst because they have lost sensation in their extremities. Neuropathy manifests not only with burning/tingling/itching “phantom” pain, but many times with complete loss of sensation. Neuropathy can allow injuries to go unnoticed, and therefore untreated–often times past the point of recovery in the wounded area.
Prevention is the Best Medicine
The best possible scenario for a diabetic is that the skin is never broken or otherwise traumatized. This means safe, careful care of the body, but especially the feet.
Why are the feet any different than any other body part?
Because the sheer distance away from the core means reduced circulation and less oxygen, nutrients and waste removal is happening. Wound management is simply different for the feet than any other area of the body.
In a survey of nursing textbooks, foot care was barely addressed–maybe a few paragraphs–a page or two at the best. Yet nurses are the front-line foot care providers for many patients. They see the patients before the doctor ever walks in the room and are more likely to hear complaints of foot pain. They provide the primary care for many patients–including providing Routine Foot Care.
Routine Foot Care
As defined by Medicare, Routine Foot Care (RFC) includes tasks such as cutting or removal of corns and calluses, the trimming, cutting, and clipping of nails, or hygienic or other preventive maintenance, including cleaning and soaking the feet. Many times these tasks are performed by nurses, allocating the doctors’ time spent with the patient to more pressing health issues.
RFC may be a very simple task under ordinary circumstances; however, when there is the presence of a chronic illness, especially one which impedes healing, the risks associated with little “nips” or “cuts” during procedures become overwhelming.
RFC by Trained Foot Care Nurses
In many states, nurses working within their scope can perform RFC for their patients, while in others, a specialty certification is required. Once such specialized certification is the Certified Foot Care Nurse® by the WOCNCB. Whether a nurse seeks this certification or not, this specialized training is a must for all nurses who provide foot care as primary care providers. To learn more about foot care training programs, visit www.prof-ed.com
(1)CDC Review Preventing foot ulcers in patients with diabetes Singh N, Armstrong DG, Lipsky BA JAMA. 2005 Jan 12; 293(2):217-28.