Diabetic Neuropathies, Foot and Leg Problems
Diabetic Neuropathies :
group of diseases that affect all types of nerves, including peripheral (sensorimotor),
autonomic and spinal nerves. 50% in patients who have had diabetes for 25 years .
Peripheral Neuropathy :
•
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most commonly affects the distal portions ( nerves of the lower extremities)
it affects both sides of the body symmetrically and may spread in a proximal
direction .
•
Half of patients with diabetic neuropathy do not have symptoms.
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initial symptoms may include paresthesias (prickling, tingling, or heightened
sensation) and burning sensations (especially at night).
•
As the neuropathy progresses, the feet become numb. and a decreased sensation of
light touch may lead to an unsteady gait
Decreased sensations of pain and temperature place patients with neuropathy at increased
risk for injury and undetected foot infections.
physical examination: a decrease in deep tendon reflexes and vibratory sensation is
found.
For patients who have few or no symptoms of neuropathy, these physical findings may be
the only indication of neuropathic changes.
Management:
intensive insulin therapy and control of blood glucose levels delay the onset and slow the
progression of neuropathy.
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Foot and Leg Problems :
Between 50% and 75% of lower extremity amputations are performed on people with
diabetes.
Complications of diabetes that contribute to the increased risk of foot problems and
infections include the following:
• Neuropathy:
Sensory neuropathy leads to loss of pain and pressure sensation,
Motor neuropathy results in muscular atrophy, which may lead to
changes in the shape of the foot.
• Peripheral vascular disease:
Poor circulation of the lower extremities contributes to poor wound healing and the
development of gangrene.
• Immunocompromise:
Hyperglycemia impairs the ability of specialized leukocytes to destroy bacteria.
Therefore, in poorly controlled diabetes, there is a lowered resistance to certain infections.
The typical sequence of events in the development of a diabetic foot ulcer :
1. soft tissue injury of the foot,
2. formation of a fissure between the toes or in an area of dry skin, or formation of a callus
3. Patients with an insensitive foot do not feel injuries,
If the patient is not in the habit of thoroughly inspecting both feet on a daily basis, the injury
or fissure may go unnoticed until a serious infection has developed.
Drainage, swelling, redness of the leg (from cellulitis), or gangrene may be the first sign of
foot problems that the patient notices.
▪
Treatment of foot ulcers involves bed rest, antibiotics, and débridement. In
addition, controlling glucose levels (important for promoting wound healing) .
▪
When peripheral vascular disease is present, foot ulcers may not heal because of
the decreased ability of oxygen, nutrients, and antibiotics to reach the injured
tissue.
▪
Why Amputation may be necessary ?
to prevent the spread of infection, particularly if it involves the bone (osteomyelitis).
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Risk factors include:
• Duration of diabetes more than 10 years
• Age older than 40 years
• History of smoking
• Decreased peripheral pulses
• Decreased sensation
• Anatomic deformities or pressure areas (eg, bunions, calluses, hammer toes)
• History of previous foot ulcers or amputation
Management:
Teaching proper foot care is a nursing intervention that can prevent costly and painful
complications that result in disability.
Preventive foot care begins with Daily assessment of the feet,:
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inspect daily for any redness, blisters, fissures, calluses, ulcerations, changes in skin
temperature, or development of foot deformities .
** Visual impairment or decreased joint mobility (especially in the elderly) requires
use of a mirror to inspect the bottoms of both feet or the help of a family member in
foot inspection.
•
The interior surfaces of shoes should also be inspected for any rough spots or foreign
objects .
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All patients should be assessed for neuropathy and undergo evaluation of neurologic
status.
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Pressure areas, such as calluses, or thick toenails should be treated by a podiatrist in
addition to routine trimming of nails.
Additional aspects of preventive foot care that are taught to patients and families include:
• not to allow moisture (water or lotion) to accumulate between the toes
• Wearing closed-toed shoes that fit well. High-risk behaviors, such as walking barefoot,
using heating pads on the feet, wearing open-toed shoes, soaking the feet, and shaving
calluses, should be avoided.
• Reducing risk factors, such as smoking and elevated blood lipids, that contribute to
peripheral vascular disease.
• Avoiding home remedies, over-the-counter agents, and self-medicating to treat foot
problems.
• Blood glucose control is important for avoiding decreased resistance to infections and for
preventing diabetic neuropathy.
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PATIENT EDUCATION :
1. Take care of your diabetes.
• keep your blood glucose level within a normal range.
2. Inspect your feet every day for changes in temperature or cuts, blisters, red
spots, and swelling. (Use a mirror to check the bottoms of your feet or ask a
family member for help if you have trouble seeing.)
3. Wash your feet every day in warm, not hot, water and dry your feet well. Be
sure to dry between the toes. Do not soak your feet, do not check water
temperature with your feet; use a thermometer or elbow.
4. Keep the skin soft and smooth, rub a thin coat of skin lotion over the tops
and bottoms of your feet, but not between your toes.
6. Trim your toenails straight each week or when needed.
7. Wear shoes and socks at all times ( Never walk barefoot ) and check inside
your shoes before putting them to make sure there are no objects inside.
9. Keep the blood flowing to your feet (Put your feet up when sitting)
• Wiggle your toes and move your ankles up anddown for 5 minutes, 2 or 3
times a day.
• Do not cross your legs for long periods of time.
• Do not smoke.
10. with your health care provider.
• Check your bare feet and find out whether you are likely to have serious foot
problems. (Remember that you may not feel the pain of an injury.)
• Do not self-medicate or use home remedies or overthe-counter agents to treat
foot problems.
))" ‫ال تنسوني من دعواتكم يا رفاق‬
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