Preventative Therapy: At-risk foot care

The 26 Review

  • What is Preventative Therapy/at-risk foot care Preventative therapy for at-risk feet involves taking the necessary steps to reduce the risk of injuries or complications before they occur, particularly in patients with diabetes or peripheral vascular disease (PVD).
  • Why Patients with diabetes or PVD are at-risk for developing painful ulcers, callus, and blisters that if left untreated may lead to infection and/or surgery
  • How Regular foot inspections are recommended to check for cuts, blisters, redness, swelling, pain, and other signs of damage. Wearing properly fitting shoes and avoiding high-impact sports/activities can help patients avoid problems.
  • Recommended For Patients with diabetes or seniors with PVD

Let’s take a closer look…

Preventative therapy for at-risk feet involves taking steps to reduce the risk of foot-related ailments and complications before they occur. This type of therapy is particularly important for people with conditions such as diabetes and/or PVD. Some examples of preventative therapy include regular foot inspections to check for cuts, blisters, or other signs of damage, as well as wearing properly fitted shoes and avoiding high-impact activities that could cause injury. Other preventative measures may include maintaining good foot hygiene, managing blood sugar levels, and performing foot exercises to improve circulation and flexibility. By taking these steps, people with at-risk feet can help prevent complications and maintain their foot health over time. 

Diabetic Foot

Diabetic foot is a serious complication associated with diabetes that aggravates an individual’s condition. Increasing patient awareness and in turn their ability to identify “foot at risk”, along with proper foot care can help prevent diabetic foot ulceration, all while reducing the risk of amputation. Physical examination of diabetic foot is mostly based on the assessment of the skin, as well as of the vascular, neurological, and musculoskeletal systems. The medical professional will inspect the skin on the legs and feet, in addition to taking a close look at each toenail. Insufficient blood flow to a limb caused by peripheral vascular disease can have a significant influence on the healing process of an ulcer, leading to persistent non-healing ulcers that are vulnerable to infection. The medical professional should also assess the temperature of the feet and legs. Elevated temperature is typically associated with sudomotor dysfunction and proposes a high risk for foot ulceration. Symptoms such as burning, pins and needles, shooting, sharp or stabbing pains, numbness, and muscle cramps are usually present in the case of peripheral neuropathy. 

Calluses & Thick Toenails

Calluses are super tough areas of thickened skin that can develop on the feet and toes. Oftentimes, calluses form on the balls of the feet or the tops of the toes. In certain cases, calluses can develop under the toenails. This ailment is caused due to pressure and friction, such as wearing too-tight shoes that continually rub against the skin. 

Thick and hard-to-trim toenails is a common issue many people tend to deal with. There are several possible causes of thick toenails including, toenail fungus, diabetic complications, poor circulation, psoriasis, toenail trauma, and ill-fitting footwear. Individuals with diabetes are at an increased risk of developing vascular issues, which doubles the risk of developing toenail fungus. 

Peripheral Vascular Disease (PVD)

Peripheral vascular disease (PVD) or peripheral arterial disease (PAD) are gradually progressing circulatory conditions that result in the narrowing or blockage of the blood vessel walls due to the buildup of plaque-like substances. Narrowing the artery walls has a major effect on the circulation of blood through various organs and the extremities (upper and lower). The upper and lower extremities are most commonly affected by PVD. There are a variety of treatment and prevention methods associated with peripheral vascular disease.

Why Preventative Therapy 

Preventative therapy for diabetes and PVD is crucial and typically involves a few lifestyle modifications and medication(s). Regular check-ups with a podiatrist is important for individuals at risk for these conditions, as early detection and treatment can significantly reduce the risk of complications. 

How: Steps for at-risk foot care

Generally, the treatment for diabetic foot ulcers includes debridement of the wound, management of the infection, and off-loading the ulcer. Other additional add-on therapies have been suggested as beneficial, those include hyperbaric oxygen therapy, advanced wound care products, and negative pressure wound therapy. Speaking with your podiatrist to determine what treatment plan is right for you is the most important first step. 

Callus debridement is typically carried out in all acute and chronic wounds, in order to remove surface debris and necrotic tissues. During this process, the podiatrist will shave away the thick layers of built-up skin and bacteria with a surgical blade. In cases of severe calluses that don’t improve with debridement, the podiatrist may recommend cortisone injections. These injections aid in easing the pain of extra-tough calluses. Patients with chronic thickened toenails will receive a similar treatment. During the treatment, the doctor will sand, buff, and remove excess nail cells from the toenails to make the patient as comfortable as possible. Callus and toenail maintenance, regardless of a present medical condition or not, is important for the overall health of the feet. 

Patients struggling with PVD can do a few things to help prevent developing ulcers, calluses, and thickened toenails. Those prevention options include the following:

  • Lifestyle modifications
    • Avoid smoking and nicotine products 
    • Healthy and balanced diet – avoid fatty foods, trans fats, and reduce your daily sodium intake
    • Exercise – daily walking can help reduce pain in the lower extremities
    • Minimize stress levels
    • Overall management of underlying disease(s) – meet with your doctor to help manage any and all underlying systemic conditions like hypertension, diabetes, and high cholesterol 

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