Foot problems

Three key factors are involved in the causation of diabetic foot problems neuropathy, ischemia, and immunologic defects. Any of these disorders can occur in isolation however, they frequently occur together. 

It is important to check that a patient presenting with a foot problem does not have diabetes. Diabetic patients are at an increased risk of developing infections because of injury from the keratolytic action of salicylic acid. Patient should be advised to apply petroleum jelly to the skin surrounding the area where salicylic acid will be applied. Petroleum jelly protects the skin from the irritation caused by the salicylic acid. Using a file or pumice stone to gently rub away the surface of the corn or calluses helps to remove them. 

NICE (National Institute for Health and Clinical Excellence) (2004) Type 2 diabetes prevention and management of foot problems. Available at http //www.nice.org.uk/ guidance/index.jsp action=bylD o=10934 [Accessed 03 July 2008],... 

Patients should be advised to check their feet daily for problems and to wash in warm (not hot) water and carefully dry their feet daily. They should be encouraged to wear well-fitted shoes and hosiery and cautioned against skin removal, including com removal, without expert help. Over-the-counter preparations for foot problems such as corn removal are not suitable for patients with diabetes. 

A young woman (about 18 years) asks if you have something for a foot problem. 

Particular care is needed with certain groups of at-risk patients wanting to self-care for foot problems, including elderly people and patients with diabetes or peripheral vascular disease. These patients should be referred to either a chiropodist or their general practitioner, for the following reasons ... 

Three major types of foot infections are seen in diabetic patients deep abscesses, cellulitis of the dorsum, and mal perforans ulcers. Most deep abscesses involve the central plantar space (arch) and are caused by minor penetrating trauma or by an extension of infection of a nail or web space of the toes. Skin infections of the dorsal area generally arise from infections in the toes that are related to routine care of the nails, nailbeds, and calluses of the toes. Mal perforans ulcer is a chronic ulcer of the sole of the foot. The ulcer develops on thickened, hardened calluses over the first or fifth metatarsal. Mal perforans ulcers are associated with neuropathy, which is responsible for the misalignment of the weight-bearing bones of the foot. Osteomyelitis is one of the most serious complications of foot problems in diabetic patients and may occur in 30% to 40% of infections. ... 

A podiatrist has studied for three years to obtain a degree in podiatric medicine and Registration. Podiatrists are independent clinicians, qualified to diagnose and treat foot problems. They may specialize in particular areas of work, for example diabetology, rheumatology or sports medicine. With the exception of nail surgery, podiatrists undertake the treatment of foot problems by non-invasive methods (until recently podiatrists were known as chiropodists). 

In this chapter we will focns on a modem treatment approach to diabetic foot problems with special emphasis on pharmacological therapies. 

Discomfort due to foot problems not only lowers productivity it also leaves workers distracted and less likely to observe safe working procedures, heightening the possibility of accidents. 

O Job enlargement Include more and varied tasks in a worker s duties. This increases the range of body positions and motions, lessening the risk of the individual developing foot problems. 

Rest breeiks If redesigning a job is impractical, frequent short breaks (rather than fewer longer breaks) help to alleviate foot problems. 

For a job redesign to effectively reduce foot problems, it must be combined with a redesign of the workplace. 

Socks, surprisingly, are also a common contributor to foot problems. Socks or stockings worn with poorly-fitted shoes cramp toes, wrinkled or too-large socks cause bhsters and the dyes in eolored socks can trigger allergic reactions in some people. Legendary UCLA basketball coach John Wooden would instruct his players in their first practice of the season how... 

Safety-related features are crucial when selecting footwear. Remember comfort is important, too. If your workers wear top-quality but ill-fitting safety boots all day they can be at risk for debilitating long-term foot problems. 

Every day few numbers of orthotics patient visit UMMC, as follows 80-90 percent of the lower limb orthoses were static and 5 percent was dynamic.80-90 percent lower limb orthotics patients did not have proper gait training with their prescribed orthoses.90-95 percent patients with the foot problem got their orthoses. Insoles and AFO s were the most common prescribed lower limb orthoses. The quality of orthopedic shoe was not acceptable to most of the users. 

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