General Footcare

General Footcare

Diabetic Foot Ulcers

High sugar levels experienced by people with diabetes can lead to nerve and blood vessel damage. Neuropathy (nerve damage or dysfunction) is the most common complication of diabetes and affects up to 50% of all diabetics. It is considered one of the most important factors in the development of diabetic foot ulcers (Laing, 1998). Neuropathy presents in three forms: motor, sensory and autonomic, each of which has significance in relation to foot ulceration.

The damage caused by high blood sugar levels can have a knock-on effect on three types of nerves:

  • Sensory nerves, leading to a loss of sensitivity to damage, pain, temperature, or vibrations. This results in a lack of awareness of damage to the feet, and increases the chance of a patient continuing to walk on damaged parts of the foot and further delaying healing. 
  • Motor nerves, affecting the lower extremity muscles which can result in deformity to the toes and feet. This creates new pressure points which can be susceptible to rubbing against the shoes, causing skin to break down.
  • Autonomic nerves, which results in reduction of sweat production, leaving the skin dry and inelastic.  This increases the risk of the skin cracking.

Because of Neuropathy, small cuts and cracks in the skin of the foot can easily turn into diabetic foot ulcers.

Diabetes can also affect Fibroblast activity and collagen formation, causing wounds to take a lot longer to heal and become likely to relapse even when healed.

The effects of hypoglycaemia on blood circulation and white blood cell count means that any injuries will not heal as quickly as in a non-diabetic person, which increases the risk of infection from seemingly minor cuts or scratches. Infection and other complications resulting from ulcers may necessitate limb amputation. Lower extremity amputation is from 15 to 46 times (Armstrong and Lavery, 1998) more frequent for those with diabetes, a procedure that can have life-threatening complications. Therefore protecting the feet from damage can be a life-saver.

General Footcare
Foot Ulcer Prevention

Foot Ulcer Prevention

Shear Comfort footwear works to protect feet in many ways:

 
  • High density wool helps to protect the feet from external damage
  • External seams reduce the possibility of seams causing friction or pressure against the foot.
  • Pressure redistribution properties of wool dissipate pressure from the feet, helping to keep the skin healthy
  • Shear reduction properties of wool reduce the risk of friction damage
  • Warmth from the insulation in the wool helps to promote better blood circulation

Foot Ulcer Healing

When recovering from a foot ulcer it is very important to protect the feet from further damage and create a good environment for healing.

The NICE guidelines (2004) recommend that patients who have experienced a foot ulcer ‘ensure an effective means of distributing foot pressures, including specialist footwear.’   Guidelines from the Association for the Advancement of Wound Care (2010)recommend that the ulcerated area is kept at an elevated temperature, away from potential shear and friction, that the area is kept free from all bodily excretions and to avoid trapping moisture against the skin if at all possible.

Shear Comfort assists the healing process by 

  • Re-distributing foot pressure with wool
  • Ensuring that there are no high pressure points inside the shoe by using external seams
  • Improving airflow around the foot, helping the skin to breathe
  • Wicking perspiration away
  • Keeping the area warm
  • Protecting the wound from being knocked

References:

Armstrong, D., Lavery, L.A., 1998. Diabetic Foot Ulcers: Prevention, Diagnosis and Classification. Am Fam Physician, 1998 March 15:57(6):1325-1332

Association for the Advancement of Wound Care (AAWC), 2010. Association for the Advancement of Wound Care guideline of pressure ulcer guidelines. Malvern (PA): Association for the Advancement of Wound Care (AAWC);14p

Laing, P., 1998. The development and complications of diabetic foot ulcers. The American journal of surgery, August 1998; 176 (2), Supplement 1:11-19 

National institute of clinical excellence, January 2004. CG10 Type 2 diabetes - footcare: quick reference guide. [online] Available at: www.nice.org.uk/CG010quickrefguide [accessed 20 March 2013]

Foot Ulcer Healing
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