- 1). Give an overview of why diabetics are prone to getting leg and foot wounds. Include basic concepts of diabetic neuropathy. Describe events leading up to ulceration: nerve degeneration, loss of sensation, skin breakage and ulceration. Point out that unchecked ulceration can lead to gangrene and amputation. Discuss the role of glucose control in neuropathy. Give case examples of good wound recovery and of poor wound management.
- 2). Explain proper foot care procedures, including daily routines, washing and drying, cutting nails, and professional callus trimming.
- 3). Demonstrate how to inspect feet and legs for ulceration. Teach to look for opacity and openings in the skin. Tell what to do and when to seek medical attention if skin is broken. Show how a mirror can be used to inspect the bottoms of feet. Note that diabetics typically have visual problems, so stress the importance of checking legs and feet in a well-lit area and while wearing corrective lenses. Discuss that many first-time ulcer patients aren't even aware they have an open wound. Stress the importance of daily checking of all areas of the feet and legs; convey that early ulcer detection can lead to better wound care and prevent gangrene.
- 4). Show how to thoroughly clean and bandage a wound. Explain ulcer debridement and wound cleaning. Patients typically feel no pain with this procedure and don't require anesthetics. Discuss the importance of keeping the wound dry to prevent further infection and gangrene. Stress the importance of IV and oral medications to clear infection.
- 5). Discuss important preventive measures like wearing proper footwear. Kicking or stepping on something hard while barefoot can easily break open the skin on a diabetic foot. Shoes should enclose the toes, fit well and must be worn at all times, except at bedtime. Feet should be thoroughly checked for skin breaks before putting on shoes.
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