UNIT FOUR LESSON 11 OUTLINE Tell participants: Taking care of your feet is an important part of diabetes management. Diabetes is the leading cause of amputations of the lower limbs. In Kentucky, there were 1,186 hospitalizations for lower extremity amputations due to diabetes in 2003. Many of these amputations could have been avoided if blood glucose levels were kept as close to normal as possible. Your A1C test lets you and your doctor know how well you are managing your diabetes. Read and briefly describe objectives to participants. Dristibute Factsheet
High levels of blood glucose can lead to neuropathy; therefore, keeping blood glucose levels as close to normal as possible is important. Peripheral vascular disease makes it more difficult for sores and infections to heal. Keeping blood glucose levels close to normal slows the onset and progression of the foot problems we are about to discuss. Wash feet with a mild soap and dry well. Ask your doctor about a good lotion to use to keep the skin moist. People with diabetes tend to get dehydrated more easily. Drink enough water to keep the body and skin hydrated. The Institute of Medicine recommends that men drink 13 cups of water and women drink nine cups. This includes the water from beverages. Caffeinated beverages should be kept at a minimum. Tell participants: Corns and calluses are tough layers of skin that have become thick and hard from too much friction and pressure on the same spot. Do not cut corn and calluses or use liquid corn or callus remover.
Blisters occur because of friction or constant rubbing on the same spot. A common way to get a blister is by wearing ill-fitting shoes. If unrecognized or untreated, a blister can become infected and lead to more serious problems. It is important for people with diabetes to wear shoes that fit well and use socks to prevent blisters. Ingrown toenails happen when an edge of the nail curves down and grows into the toe. This is most frequently seen on the big toe. Ingrown toenails can be painful and can cause infections. Have your doctor or podiatrist trim ingrown toenails. To prevent an ingrown nail, cut toe nails straight across and avoid shoes that are too tight. Bunions form when your big toe slants toward the small toes and the place between the bones near the base of your big toe grows larger. Avoid wearing pointed, ill-fitting shoes or high heels. Plantar warts form at the bottom of the foot and are caused by the human papillomavirus (HVP) type 1.
Hammertoes form when the foot muscle gets weak. This can happen with diabetic nerve damage. The weakened muscle makes the tendon in the foot shorter and makes the toes curl under the feet. To prevent hammertoe, wear proper fitting shoes. Dry and cracked skin occurs because the nerves that control the oil and moisture in your foot no longer work. This makes skin dry, itchy, and prone to cracks and infections. It is important to keep clean and use lotions to prevent dryness. Athlete s foot is a fungus that causes itchiness, redness, and cracking of the skin. Ask participants why athlete s foot would be a problem for a person with diabetes. Answer: Germs can enter through the cracks in the skin and cause an infection. Try to set a specific time to check your feet every day. If you have eye problems, have someone check your feet for you. It is important to check feet daily to identify problems early and prevent them from getting worse.
Read the information on the slide and ask participants for a reason why they would follow each piece of advice for the care of the feet. Use a thermometer or your elbow to make sure the temperature of the water is not too hot A person with diabetes may lose feelings in his or her feet and may not be able to tell the temperature of the water. It is easy for such a person to put his or her feet into water that is too hot and get burned. Avoid soaking your feet This makes skin dry and prone to infections. Dry your feet well after washing and pat your skin dry instead of rubbing Drying your feet well prevent infections. Pat instead of rubbing to avoid breaking the skin. (continued from previous slide) Read the information on the slide and ask participants for a reason why they would follow the advice for the care of the feet. Do not put cream or lotion between your toes This could cause an infection. Read information on slide.
If there are serious foot problems, the feet should be checked at every doctor s visit. Ask participants why they should ask the questions: Are the nerves in my feet healthy? If the nerves are damaged there might be a cut on the feet and the person may not know it until it gets infected. How is the blood flow to my legs and feet? Poor blood flow makes it difficult for cuts and infections to heal. What exercises should I do? Your doctor will tell you which exercises are appropriate for you based on your condition. How should I trim my toenails? After washing the feet and when they are soft, cut straight across, and avoid cutting into the corners. Use a nail file or emery board to smooth the nails after trimming. What lotions or creams should I use? Your doctor will suggest appropriate cream and lotions.
Choose socks that are made of cotton, wool, or a cotton-polyester blend. These types of socks keep the feet dry. Ask participants why they should protect their feet from heat and cold. Have extra chairs for participants to try exercises that keep blood flowing to the legs and feet. At this time, the health professional who was invited to speak can talk to participants about selecting proper fitting shoes.
Ask participants to give a reason why they would follow the advice on the slide. Ask participants for reasons for choosing proper shoes. Avoid shoes with high heels and pointed toes Answer: They put excessive pressure on the foot and can cause foot ulcers. Avoid shoes such as sandals that expose your toes and heels Answer: They increase your risk for injury and infection. Ask participants if they have noticed any of these problems. Allow time for them to share. At this time, show the Diabetes Education Series CD and select the section on Foot Care, or have participants share experiences caring for their feet.
Allow time for participants to share their feelings and experiences. If possible, have someone in the group share their experiences of living with diabetes and foot care. 1. Ask participants how they did in accomplishing their goal from last week. (a) For those who accomplished their goals, ask what actions were taken to be successful. Provide incentives for those who met their goals (b) For those who did not accomplish their goals, ask if they took steps to meet their goals. If they did, acknowledge that they are moving in the right direction. 2. Move onto talking about the goal for this week. 3. Participants should set a goal related to the daily, weekly, and yearly care of their feet. 4. The participants can record the goal on the Goal Setting Worksheet (found in the Appendix for this Lesson 10 and should be in their folders from last week). 5. Having a foot exam done every year is also an important part of the Diabetes Checklist. Take time now to review the Checklist and have participants check off behaviors that they have completed since the program started. The answers to the PowerPoint questions can be found in the appendix for this lesson. Show the next slide as you read the story.
Keith, a 70-year-old smoker, was diagnosed with type 2 diabetes at age 50. He noticed that he has little feeling under his feet as he walks around the house without slippers. He normally checks his feet once a month and soaks his feet to keep his toenails soft. Keith is afraid to cut his toenails and they are so long that his shoes no longer fit and he had to purchase oversized slippers. He has not been to the doctor in two years. What is Keith s problem? His blood glucose is not in control and he seems to be experiencing neuropathy (loss of feelings in the legs and feet), and some peripheral vascular disease (poor blood flow in the legs and feet). Why is this problem for Keith? He may have a sore or blister on his feet and may not know it until it becomes infected. His poor circulation can make it difficult for sores and infections to heal. Such problems may lead to gangrene and amputation if not treated. What are some things that Keith needs to do to solve this problem? (List as many suggestions as possible.) Keith should: (a) see a doctor about his problem; (b) begin checking his feet daily for dry cracked skin, blisters, and other problems (he may have to ask someone to check his feet for him, as it seems his vision is not too good); (c) not soak his feet, but instead wash them in warm water daily, pat them dry, use talcum powder to keep the area dry, and use lotion on the top and the bottom of feet; (d) have a doctor trim his nails; (e) see the doctor once a year; (f) wear socks and slippers at all times to prevent blisters; (g) wiggle his toes to improve circulation and avoid crossing his legs; (h) avoid smoking; and (i) ask his doctor how to choose shoes. What do you think is the best solution and why? Have participants share their best solutions and the reasons why they selected them.
The handout with completed answers can be found in the Appendix for this lesson. The handout for participants to complete will be in their folders. The questions can be completed as group work or take-home work. Tell participants to find the Recipe: Spicy Snack Mix and the Recipe: Chili Bean Dip with Wrap in their folders. Take some time to allow participants to share what they learned this week. Allow the group to discuss ways in which they can support each other.