Diabetes makes the feet vulnerable to foot problems that can develop into infections leading to amputation and disability. More than 35,000 patients of Parkland Health & Hospital System have diabetes that puts them at risk for a diabetic foot wound.
However, proper preventive care can dramatically reduce the incidence of infection and amputation, and can provide better management for patients at risk, research shows. Taking a major step to prevent severe foot problems, the Global Diabetes Program at Parkland recently launched the ‘Healthy Feet’ initiative designed to identify patients at high risk for a diabetic foot problems and connect them with risk-stratified preventive foot services.
The program will place three specialty foot care teams overseeing the new preventive care strategy at Parkland Community Oriented Primary Care (COPC) health centers throughout Dallas County. Each team will be comprised of a non-surgical podiatrist, a registered nurse with specialty foot care training and a senior medical assistant.
“Amputation and foot ulceration are common and feared complications of diabetes mellitus. Many times these unfortunate complications can be prevented with proper foot care, screening and timely intervention,” said Javier LaFontaine, DPM, MS, a podiatrist at Parkland’s Foot Wound Clinic.
“The Healthy Feet program enables us to identify at-risk patients with diabetes, as well as any patient with a foot anomaly to reduce complications and improve patient care, prevent unnecessary emergency room visits and surgeries and provide greater access to foot care specialists in the community,” said Kellie Rodriguez, RN, MSN, MBA, CDE, Director of Parkland’s Global Diabetes Program.
To promote the right care for the right patient at the right time, a new foot risk assessment tool in the electronic health record determines if a referral for specialized foot services is required. A risk stratification score automatically assigns patient risk from highest (category 4) to lowest risk (category 0) and generates a recommended clinical management pathway that can include orders for further assessment such as X-rays.
Those identified with an urgent condition will be referred to the Foot Wound Clinic or Emergency Department at Parkland Memorial Hospital. Moderate risk categories 3 and 2 will be cared for by the foot service teams at one of Parkland’s COPC health centers, while lowest risk categories 1 and 0 will be managed by primary care health providers at Parkland COPCs.
One of the 12,000 patients seen last year at Parkland’s Diabetic Foot Wound Clinic, Samuel Whitaker, 59, was diagnosed with type 2 diabetes more than 25 years ago. A few years later while living in Houston, he had surgery for amputation of all of his toes. Poor nutrition, obesity, lack of exercise and a reluctance to change had caught up with him.
“I was hard-headed,” Whitaker admitted. “I didn’t take good care of myself.”
Focused on preventing foot ulcers that too often result in amputations like Whitaker’s, the Healthy Feet initiative prioritizes education for both patients and primary care teams, Dr. LaFontaine said, adding, “One of the key roles of the nurses on each team will be providing in-depth foot care training to staff at the health centers, along with enhanced patient education.”
Dr. La Fontaine provided the following tips for patients with diabetes to help maintain foot health and avoid complications:
- Manage your diabetes. Work closely with your healthcare provider to keep your blood glucose in target range.
- Check your feet daily. Examine your bare feet for cuts, blisters, sores and swelling. Use a mirror to check the bottoms of your feet, or ask someone else to help.
- Wash your feet daily and dry them carefully, especially between the toes.
- Moisturize your skin daily, rubbing a thin coat of lotion on the tops and bottoms of your feet, but not between the toes where moisture can lead to the development of fungus.
- Wear appropriate footwear that protects your feet and fits properly; ask your physician if you qualify for Medicare coverage for special shoes.
- Stay active. Develop an exercise and activity schedule with your healthcare provider to promote fitness and a healthy weight.
- Keep toenails trimmed. Cut your toenails straight across and file edges smooth with an emery board. Get professional help if you’re not able to do this yourself.
- Protect your feet by wearing shoes and socks. Never walk barefoot. Wear 100 percent cotton white socks that are breathable and will show blood stains if you have a wound.
- Protect your feet from temperature extremes. Test water with your elbow before putting your feet in bathtub. To prevent burning your feet without realizing it, never use heating pads, space heaters, electric blankets or hot water bottles.
- Improve circulation. Elevate your feet whenever possible when sitting. Avoid crossing your legs for long periods and wiggle your toes and ankles several times a day.
- Don’t smoke. Smoking is bad for circulation and is a risk factor for many serious conditions, including cancer, heart disease, diabetes and stroke.
