Canadian Diabetes Association Clinical Practice Guidelines Foot Care

Canadian Diabetes Association
Clinical Practice Guidelines
Foot Care
Chapter 32
Keith Bowering, John Embil

Foot Care Checklist 2013
EDUCATE about proper foot care
EXAMINE for structural, vascular, neuropathy

problems
DO a 10 gram monofilament assessment
IDENTIFY those at high risk of foot ulcers and

educate, assess more frequently, consider footwear
REFER ulcers to multidisciplinary team specialized in
foot care
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca

Copyright 2013 Canadian Diabetes Association
Patients with DM are 20X More Likely to be
Hospitalized for Non-traumatic Limb Amputation

Public Health Agency of Canada (August 2011); using 2008/09 data from the Canadian Chronic Disease Surveillance System (Public Health Agency of Canada).
Prevention through education
Proper risk assessment
Early and aggressive treatment

Educate Patients on Proper Foot Care The DOs
DO
Check your feet every day for cuts, cracks, bruises, blisters, sores, infections, unusual
markings
Use a mirror to see the bottom of your feet if you can not lift them up
Check the colour of your legs & feet seek help if there is swelling, warmth or redness
Wash and dry your feet every day, especially between the toes
Apply a good skin lotion every day on your heels and soles. Wipe off excess
Change your socks every day

Trim your nails straight across
Clean a cut or scratch with mild soap and water and cover with dry dressing
Wear good supportive shoes or professionally fitted shoes with low heels (under 5cm)
Buy shoes in the late afternoon since your feet swell by then
Avoid extreme cold and heat (including the sun)
See a foot care specialist if you need advice or treatment
Educate Patients on Proper Foot Care The DONTs
DO NOT
Cut your own corns or callouses
Treat your own in-growing toenails or slivers with a razor or scissors. See your
doctor or foot care specialist
Use over-the-counter medications to treat corns and warts
Apply heat with a hot water bottle or electric blanket may cause burns unknowingly
Soak your feet
Take very hot baths

Use lotion between your toes
Walk barefoot inside or outside
Wear tight socks, garter or elastics or knee highs
Wear over-the-counter insoles may cause blisters if not right for your feet
Sit for long periods of time
Smoke
guidelines.diabetes.ca| 1-800-BANTING (226-8464) | diabetes.ca
How to Perform Proper Foot Examination
Skin changes
Structural Evidence of infection
Abnormalities Callous or ulcer
Range of motion
Charcot foot
Peripheral Temperature
Arterial Skin changes
Assessment Ankle Brachial Index
Neuropathy
10 gram monofilament
Assessment
Rapid Screening for Diabetic Neuropathy Using
10 gram Semmes-Weinstein Monofilament
Loss of sensation over the distal plantar surface to the 10g

monofilament is a significant and independent predictor of foot
ulceration and lower-extremity amputation.
Who is at High Risk of Developing a Foot
Ulcer?
Peripheral neuropathy
Monofilament sensation loss
Previous ulceration or amputation
Structural deformity or limited joint mobility
Peripheral arterial disease
Microvascular complications
Elevated A1C
Onychomycosis

When Should a Foot Exam be Performed?
Low Risk Annually
High risk for More frequent

ulcer E.g. Every 3-6 months
Refer to multidisciplinary
Foot ulcer team with expertise in
present foot ulcers

High Risk for Ulcer: Prevention and Early
Treatment
Foot care education

High risk for
ulcer Professionally-fitted
footwear
Prompt referral to
If ulcer multidisciplinary team with
develops expertise in foot ulcers

Foot Ulcer: Multidisciplinary Team Approach
Wound care
Local factors Pressure offloading
Debridement
(nonischemic wounds)
Glycemic control
Systemic Treat infection
factors Address lower-extremity
vascular status
Recommendation 1
1. In people with diabetes, foot examinations by

healthcare providers should be an integral
component of diabetes management to identify
persons at risk for ulceration and lower-extremity
amputation [Grade C, Level 3] and should be performed
at least annually and at more frequent intervals in
those at high risk [Grade D, Level 4]

Recommendation 1 (continued)
1. Assessment by healthcare providers should include
the assessment of skin changes, structural
abnormalities (e.g., range of motion of ankles and
toe joints, callus pattern, bony deformities), skin
temperature, evaluation for neuropathy and
peripheral arterial disease, ulcerations and
evidence of infection [Grade D, Level 4]

Recommendation 2
2. People at high risk of foot ulceration and

amputation should receive foot care education
(including counseling to avoid foot trauma),
professionally-fitted footwear, and early
referrals to a healthcare professional trained in
foot care management if foot complications occur
[Grade B, Level 2]

Recommendation 3
3. Individuals who develop a foot ulcer should be

managed by a multidisciplinary healthcare team
with expertise in the management of foot ulcers to
prevent recurrent foot ulcers and amputation [Grade
C, Level 3]

Recommendation 4 2013
4. There is currently insufficient evidence to

recommend any specific dressing type for
diabetic foot ulcers [Grade C, Level 3]. General
principles of wound management involve the
provision of a moist wound environment,
debridement of nonviable tissue (nonischemic
wounds) and offloading of pressure areas [Grade B,
Level 3]

Recommendation 5 2013
5. Evidence is currently lacking to support the

routine use of adjunctive wound- healing
therapies such as topical growth factors,
granulocyte-colony stimulating factors, dermal
substitutes, or HBOT in diabetic foot ulcers but
they may be considered in nonhealing,
nonischemic wounds when all other options have
been exhausted [Grade D, Level 4]

CDA Clinical Practice Guidelines
www.guidelines.diabetes.ca for professionals
1-800-BANTING (226-8464)
www.diabetes.ca for patients


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Canadian Diabetes Association

Clinical Practice Guidelines

Keith Bowering, John Embil

EDUCATE about proper foot care

EXAMINE for structural, vascular, neuropathy

IDENTIFY those at high risk of foot ulcers and

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca

Proper risk assessment

Early and aggressive treatment

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca

Change your socks every day

Cut your own corns or callouses

Soak your feet

Take very hot baths

Wear tight socks, garter or elastics or knee highs

Loss of sensation over the distal plantar surface to the 10g

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca

Low Risk Annually

High risk for More frequent

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca

Foot care education

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca

1. In people with diabetes, foot examinations by

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca

2. People at high risk of foot ulceration and

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca

3. Individuals who develop a foot ulcer should be

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca

4. There is currently insufficient evidence to

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca

5. Evidence is currently lacking to support the

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca

www.guidelines.diabetes.ca for professionals

www.diabetes.ca for patients

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca

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