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Guidelines on Foot Ulcer prevention - Coggle Diagram
Guidelines on Foot Ulcer prevention
ADA 2022
Screening at diagnosis and then annually (IDF 2014) (V Rensburg 2012) (Steed 2008) (Wong 2012) (Hart 2017) SEMDSA (NICE 2015) (IWGDF 2019), previous ulcer or amputation every visit.
History taking
Risk Factors
poor glycaemic control (Canada 2018) (Steed 2008) (Hart 2017)
Peripheral Neuropathy with LOPS (Canada 2018) (Pinzur 2005) (V Rensburg 2012) (WHO 2020) (SEMDSA 2017)
(Pain, burning, Numbness.) (Pinzur 2005) (IDF2017)
Foot deformities (Canada 2018) (V Rensburg 2012)
Charcot foot
angioplasty/ vascular surgery
Limited joint mobility (SEMDSA 2017) (Canada 2018)
Preulcerative callus or corn (V Rensburg 2012)
PAD (Canada 2018) (V Rensburg 2012) (WHO 2020) (SEMDSA 2017)
decreased walking spead (IDF2017)
leg fatigue(IDF2017)
claudication (Pinzur 2005) (V Rensburg 2012) SEMDSA (IDF2017)
History of foot ulcer (IDF 2014) (Canada 2018) (Pinzur 2005) (V Rensburg 2012) SEMDSA (IDF2017)(WHO 2020) (SEMDSA 2017) Previous hospital admission for foot ulcer (Pinzur 2005)
Amputation (IDF 2014)(Canada 2018) (Pinzur 2005) (V Rensburg 2012) SEMDSA (WHO 2020)
Visual Impairment (IDF 2014) (V Rensburg 2012)
Chronic kidney disease ( especially those on dialysis) (WHO 2020) (SEMDSA 2017)
Physical Difficulty for self management (IDF 2014) (V Rensburg 2012)
Onychomycosis (Canada 2018)
Smoking (WHO 2020)
Foot Examination
Assessment of Neuropathy
Monofilament testing 10g (IDF 2014) (Canada 2018) (Pinzur 2005) (V Rensburg 2012) (Steed 2008) (Wong 2012) (Hart 2017) SEMDSA (NICE 2015) (Baker 2020) (IDF2017) (WHO 2020) (SEMDSA 2017)
Vibration assessment with tuning fork (V Rensburg 2012) (Wong 2012) (IDF2017) (WHO 2020)
temperature sensation / pin prick sensation. (IDF 2014) (Wong 2012) (WHO 2012) (IDF2017)
Ipswitch Touch Test (IDF2017) (WHO 2020) (SEMDSA 2017)
Ankle reflexes (IDF2017)
Vascular assessment
Pulses in legs and feet (IDF 2014) (Canada 2018) (Pinzur 2005) (V Rensburg 2012) (Steed 2008) (Wong 2012) SEMDSA (Baker 2020) (IDF2017) (WHO 2020) (SEMDSA 2017)
dorsalis pedis and posterior tibial (IDF 2014) (WHO 2020)
Doppler assessment (IDF 2014) (Steed 2008) (Hart 2017) (IDF2017)
Palpation (Increased warmth) (Canada 2018) (Pinzur 2005) (IDF2017)
Delayed Capilary Refill (Pinzur 2005)
Dependent rubor (Pinzur 2005)
Gangrene - sign of irreversible arterial insufficiency. (Pinzur 2005) (NICE 2015)
Inspection (Wong 2012) (WHO 2012)
Skin
Visual evidence of neuropathy (IDF 2014)
Dry skin, dilated veins,
Discolouration and Atrophy(Pinzur 2005)
blisters and abrasions (Canada 2018) (Pinzur 2005)
subkeratotic hematomas or hemorrhage (Canada 2018)
Callusses and corns (Canada 2018) (Pinzur 2005) (Steed 2008) SEMDSA (NICE 2015)
Ulcers (Canada 2018) (Pinzur 2005) SEMDSA (NICE 2015)
absence of hair (Canada 2018) (Pinzur 2005) (V Rensburg 2012)
abnormal colour and oedema (Canada 2018) (Pinzur 2005) (V Rensburg 2012) (NICE 2015) (IDF2017)
toe nail problems (Canada 2018) (Pinzur 2005) (Steed 2008)
Infection or inflammation (NICE 2015)
Foot deformities (IDF 2014) (Pinzur 2005) (NICE 2015)
hammer / clawed toes (Pinzur 2005) SEMDSA
bone prominences (Pinzur 2005) SEMDSA
Charcot arthropathy, bony prominences (Canada 2018) (Pinzur 2005) (NICE 2015)
Number of toes (Canada 2018)
Bunnions (Pinzur 2005)
Loss of Joint mobility SEMDSA
Foot wear: Exterior: signs of wear, penetrating objects • Interior: signs of wear, orthotics, foreign bodies (Canada 2018) (Pinzur 2005) SEMDSA
Gait (Canada 2018)
Status of the Nails (Canada 2018)
Foot hygiene Cleanliness, tinea pedis (Canada 2018)
Referral
Absent pedal pulses (Wong 2012)
Smoking
lower extremity complications
Specialized footwear
severe neuropathy
foot deformities
ulcers (Wong 2012)
Callous formation (Wong 2012)
poor peripheral circulation
History of amputation
LOPS (Wong 2012)
Structural abnormalities (Wong 2012)
Peripheral Artery disease
Foot swelling and Redness (Wong 2012)
Foot ulcer with cellulites (Wong 2012)
Preventive self care education all patients with diabetes (Steed 2008) (WHO 2012) (NICE 2015)
Footwear behaviours
Do not walk barefoot indoors and outdoors.(Pinzur 2005) SEMDSA (IDF2017) (SEMDSA 2017) (IWGDF 2019)
Do not use callus and corn removers and don't cut the out yourself (Pinzur 2005) SEMDSA (WHO 2012) (WHO 2020) (SEMDSA 2017) (IWGDF 2019)
Inspect and feel the inside and shake out your shoes daily SEMDSA, (IDF2017) (WHO 2020) (SEMDSA 2017) (IWGDF 2019)
Do not wear shoes without socks. SEMDSA (IWGDF 2019)
Wear shower shoes (IDF2017)
Don't wear thin slippers (IWGDF 2019)
Appropriate footwear (Wong 2012) (WHO 2012) (NICE 2015)
Sufficient size to accomodate and insole (Pinzur 2005) SEMDSA (WHO 2020)
Padded tongue
shoes with laces, 3-4 per side. (Pinzur 2005)
Square toe box with adequate depth (Pinzur 2005) SEMDSA (Baker 2020) (SEMDSA 2017)
Cotton socks that breath and absorb perspiration (Pinzur 2005) (SEMDSA 2017)
High risk patients should wear orthotic shoes (V Rensburg 2012) (Steed 2008)(Wong 2012)
Change socks daily SEMDSA (SEMDSA 2017)
Internal shoe lenght should be 1-2 cm longer than the foot. SEMDSA (WHO 2020)
Internal width of the shoe should be equal to width of foot. SEMDSA (Baker 2020) (SEMDSA 2017)
Fitting should be evaluated when standing SEMDSA
refer to an orthotist for special foot wear if fitting shoe is too tight due to deformities and there are signs of abnormal loading. (callus and ulceration). SEMDSA (Baker 2020) (IWGDF 2019)
Heel no higher than 4cm (SEMDSA 2017)
Flexible sole (SEMDSA 2017)
smooth inner lining without seems (SEMDSA 2017)
Foot deformities (Pinzur 2005)
Daily inspection (Steed 2008) SEMDSA (WHO 2020) (SEMDSA 2017) (IWGDF 2019)
family member SEMDSA,
unbreakable mirror
reasons for inspection (IDF 2014)
Inspect for: redness, blisters, callus, ulcer, swelling, nail thickness, cuts, cracks, bruises, damaged nails and moisture between the toes as well as cracks and infection.
Agreed foot care plan and education per individual needs and risks (IDF 2014)
Insist your doctor or nurse to inspect your feet. SEMDSA (WHO 2020)
Hygiene (Pinzur 2005) (V Rensburg 2012) (WHO 2012)
Bathe the foot daily with mild soap..SEMDSA, (IDF2017) (WHO 2020) (SEMDSA 2017) (IWGDF 2019)
Use soft brush to clean about the nails
Dry feet by blotting or patting with special attention to the web spaces. Use lambswool between the toes if the skin of the web spaces stays moist or becomes macerated. SEMDSA (WHO 2020) (SEMDSA 2017) (IWGDF 2019)
Use oil, lotion or lanonin cream to avoid dryness. SEMDSA (IDF2017) (WHO 2020) (SEMDSA 2017) (IWGDF 2019)
Cut nails with square nail clipper
Test the water temperature with hand not foot. SEMDSA, (IDF2017) (WHO 2020) (SEMDSA 2017)
Cut your nails straight across SEMDSA (WHO 2012) (SEMDSA 2017) (IWGDF 2019)
Do not soak your feet in standing water or foot spa's SEMDSA, (SEMDSA 2017)
Do not apply moisturiser in between your toes. (SEMDSA) (IDF2017) (WHO 2020) (SEMDSA 2017)
Do not take care (clip toe nails) if vision is poor. SEMDSA (SEMDSA 2017)
Do not use hot water bottles and heaters near your feet. SEMDSA (SEMDSA 2017)
Do not use perfumed soaps
Do not use scissors or blades to cut your toe nails. (SEMDSA 2017)
Do not attempt to cut abnormally thickened toenails. Use a file. (SEMDSA 2017)
Do not use sharp instruments to dig around the toenails (SEMDSA 2017)
Report to care provider (Pinzur 2005) (V Rensburg 2012)
at the first sign of redness, ulceration, blister formation, nail or tissue inflammation, or infection. SEMDSA, (SEMDSA 2017) (IWGDF 2019)
Current risk of developing a foot problem and importance of glucose control (NICE 2015)
link to www.coraldivers.co.za
Classify risks (IDF 2014) (NICE 2015) (IDF2017) (WHO 2020) (IWGDF 2019)
No added risk: no risk factors and no previous history of foot ulcer or amputation. (V Rensburg 2012)
Provide foot-care education.
At risk: one risk factor and no previous history of foot ulcer or amputation. (V Rensburg 2012)
At each review: 6 monthly (Pinzur 2005)
Inspect both feet – ensure provision of local management as indicated.
Evaluate footwear – provide appropriate advice.
Enhance foot-care education.
High risk: Two or more risk factors. Previous ulcer or amputation (very high risk) (V Rensburg 2012
At each review every 3-6 months: Inspect both feet – ensure provision of local management as indicated
(Pinzur 2005)
Evaluate footwear – provide advice and specialist insoles and shoes if indicated.
Consider need for vascular assessment or referral if indicated.
Evaluate and ensure the appropriate provision of intensifi ed foot-care education.
Management
Treating Skin infections (Wong 2012) (IWGDF 2019)
Quit smoking SEMDSA (WHO 2020) (SEMDSA 2017)
Optimize glycaemic control SEMDSA
Optimize blood pressure control SEMDSA
Optimize lipid control SEMDSA
Treat Onychomycosis (IDF2017)