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Diabetic Foot Pearls of Wisdom

Discussion in 'Diabetic Foot & Wound Management' started by Craig Payne, Nov 28, 2009.

  1. Craig Payne

    Craig Payne Moderator

    Articles:
    8

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    We have had the Biomechanics Pearls of Wisdom, so what about the diabetic foot?

    I will start:

    Give diabetes an inch and it will take a foot.
    This little piggy, really did go to market.
     
  2. I'm no expert on DM podiatry, however.


    ALWAYS check inside the shoes, every time you see the patient.

    Leave aside all the things you find in there the number of times you find the sockliner is worn away or rucked up! And the most skillfull debridement and most expensive hi tech dressing in the world will do exactly squat if the patient is walking on a lump or that plastic cross strutting you get in some shoes. Check the slippers as well.
     
  3. Once you get the ulcer to heal use your biomechancial knowledge to reduce the stress on the area so it does not come back. ie Tissue stress theory.
     
  4. Why wait til then? ;)
     
  5. Johnpod

    Johnpod Active Member

    1. Diabetics are still human beings: they still need work doing

    2. Don't just tell 'em what to do - tell 'em why they need to do it

    3. Go the extra mile - put a dressing on - use an antiseptic - and follow-up where there is the least doubt

    4. Don't expect them to remember - write it down!

    5. You've got time to explain their condition to them - other medics haven't

    Craig said: "Give diabetes an inch and it will take a foot" ..... I like that!!!! It could be used to 'bring it home' to a patient who couldn't be bothered.....?
     
  6. The "foot health" of some people with diabetes can be better than the "foot health" of some people without diabetes.

    Shear forces may be significant in the aetiology of neuropathic ulceration: in-shoe pressure measurement is typically incapable of measuring shear forces.
     
  7. Johnpod

    Johnpod Active Member

    Well-controlled diabetics are probably fitter than you are.
     
  8. DaVinci

    DaVinci Well-Known Member

    Why do so many clinical trials of new wound dressing products compare the new dressing to a saline dressing? (that no one actually uses clinically). Why don't they compare them to a current commonly used treatment? (are they scared of the results?)
     
  9. Footsies

    Footsies Active Member

    Offload Offload Offload!
    :)
     
  10. cwiebelt

    cwiebelt Active Member

    There is usally a reason the client has a foot problem (actually probably several reasons)
    the common things i have found

    1/poorly controlled diabetes HbA1c (in the double digits 10 and above)
    2/a poor tack record of podiatry review and check ups, this includes education on the importace of good foot care and health and what to do.
    3/if there is a problem idetified early and aggressive intervention, and follow up to prevent more serious complicatons.
    4/compliance of the client is essential, explain why you are doing way you are doing and why. sometimes several times until everyone understands this is serious.
    5/healing a wound, Charcot foot, etc is oftern the easy part keeping it healed is the hard part.

    The issue is it qiute ofetern it requires a multidisciplinary approach at times.

    Chris
     
  11. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Its not what you put on a wound that matters, it what you take off that matters.
     
  12. blinda

    blinda MVP

    True. My top three DJ stylee points for DM wounds;

    Debride, swab, offload.
     
  13. when debriding an ulcer bleeding is only a problem if you can hear it.
     
  14. Laurie Foley

    Laurie Foley Member

    The corollary to Craig's quote "Put anything you like on the wound...as long as it is not the patient"

    Lack of perip[hral sensation is a "negative" symptom (not sure where I read that)
     
  15. markjohconley

    markjohconley Well-Known Member

    ... or if it makes the floor so slippery you can't get traction!
     
  16. Sometimes the best thing you could do to help a patients foot would be to chop off their hands!
     
  17. Dido

    Dido Active Member

    A good thread folks, let's keep it going ! :good:

    Dido
     
  18. Footsies

    Footsies Active Member

    Unless they are ischemic of course!
     
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