Unfortunately, diabetes is one of the fastest growing illnesses in America. That means if you don't currently have patients with diabetes (unlikely, but possible), you will soon. And that means you're going to be treating patients with diabetic neuropathy, particularly diabetic neuropathy affecting their feet.
Step One – The Thorough Foot Examination
If you have patients with diabetic neuropathy, even if they don't present with foot issues, you need to be proactive as their physician and ensure that you see them at least once a year for a complete foot examination. When you're examining their feet, make sure you do the following:1
- Examine each foot between the toes and from toe to heel. Make extensive notes in the chart of any problems by drawing or labeling the finding on the foot diagram. If your patient has skin that is thin, fragile, shiny and hairless, they could have problems with their circulation and that means possible nerve damage.
- Ask the patient if they've noticed any change in how their feet sweat. If their feet don't sweat as they normally would, they can develop dry, cracked skin and those cracks can become infected.
- If your patient is wearing nail polish, request that they remove it. Check for ingrown toenails, deformed nails or any type of nail fungus.
- Make notes on the diagram and in the chart of any areas on their feet that are noticeably dry, red or warm to the touch.
Step Two – Patient Education
In order to prevent serious problems, your diabetic neuropathy patients need to know how to care for their feet and what to watch for so they can come in to see you before they reach a point of no return. Here's what they should do:
- Check their feet every day. They should look at their bare feet to make sure they don't have any sores, blisters or swelling. If they can't see the bottoms of their feet, they should use a mirror or ask someone else to check them.
- Wash their feet every day and dry them completely to eliminate the possibility of fungus growth.
- Use a good lotion on their feet to keep skin smooth and prevent dry, cracked skin. They should not use lotion between the toes – it will keep the skin there too moist, and that moisture will breed bacteria.
- Trim their toenails, but not too short. Cut them straight across and file the edges with a nail file to prevent ingrown toenails.
- Always wear shoes and socks – even inside the house. If they have neuropathy, it's just too easy to step on something and injure their feet without even feeling it.
- Wear comfortable shoes, preferably shoes designed for people with diabetic neuropathy. Check their shoes before they put them on and make sure the lining is intact and smooth, and that nothing is in their shoes. Talk to them about Medicare assistance with purchasing special shoes.
- Never put their feet in hot water. Check the temperature with the elbow before stepping into it.
- Never use hot-water bottles or heating pads on their feet. Neuropathy makes it harder to sense extreme temperatures and they can burn their feet without even knowing it.
- When sitting down, they should prop their feet up to keep the blood circulating; move the toes and ankles to keep the blood pumping; and never cross their legs when sitting.
Don't just tell them what they need to do and take it for granted that they understand what you're telling them. Ask your patient to demonstrate the steps to proper foot care so you know they know what you're saying and that they are physically capable of doing what you're telling them to do.
Offer patients an ongoing monitoring and follow-up program. Keep in touch and watch for any of the symptoms of diabetic neuropathy in the feet. Diabetic neuropathy impairs the ability to feel pain in the extremities; patients may not notice the problem until it's too late for successful treatment. It never hurts to have a fresh pair of eyes (yours) keeping watch over them.
Dr. John Hayes Jr., a graduate of National College of Chiropractic, practices in Massachusetts. He also has a Master of Science in Biology and Nutrition from the University of Bridgeport and is a diplomate of the American Board of Chiropractic Orthopedists. Dr. Hayes is the founder and president of Health Solutions Group and the author of Beating Neuropathy - Taking Misery to Miracles in Just 5 Weeks! For more information, visit http://neuropathydr.com.