A Family Doctor's Tale - FOOT CARE

DOC HOW DO I TAKE CARE OF MY FEET

Typically the foot is furthest from the heart and therefore more easily plagued with problems like poor blood circulation or neurological deficit.

Therefore taking care of the foot is very important especially in  patients having diabetes mellitus ( A Simple Guide to Diabetes).

Foot care is an important tool in prevention of foot problems at all ages.



Footwear:


1.Shoes should fit comfortably.

2.Soft shoes like canvas or soft leather is preferred because they cause less pressure points.
Foam rubber shoes cause fewer planter calluses

3.The toe box should be wide and high enough to accommodate any exostosis (protruding bone) or contractures.

4.Shoes should have anterior as well as a posterior heel.
This protects the metatarsal heads from coming under stress.

5.Wearing sport shoes which are comfortable and has air bubbles at the front and back of the shoes will prevent friction in sports like jogging and brisk walking.

One of my patients will only wear sport shoes because walking in other shoes causes pain in her feet.

6.Woman's shoes should not have high heels as these increase  pressure on the planter surface and the metatarsal bones.
A low heel lace shoe is more comfortable because of the bigger toe box.

7.Specially constructed shoes may be necessary for patients with deformities of the foot.

A elderly patient has to have her shoes altered in order to allow her protruding hallus valgus toe bone to fit into the shoe.



8. Full length soft molded inlays can be used when pressure sores or painful calluses are present.


Socks:


1.Socks or stocking should fit comfortably and kept dry at all times


2.Tight constricting stocking should not be worn.


3.Loose stockings which can wrinkle should also be avoided


Foot:


1.Inspect and clean foot daily.


2.wash feet daily with bland soap and lukewarm water.
Pat dry gently  and thoroughly especially between the toes after wash.
Do not rub the foot vigorously.


3.keep your toe nails short, trimming them straight across to avoid ingrowing toenails

I must have done at least 100 partial excisions of  ingrowing big toe nails in patients who had been cutting their toe nails wrongly and wearing tight shoes.


4.moisturize feet daily to prevent dryness and cracking of skin


5.web spaces should be kept dry with powder or small pieces of cotton wool in between toes.


6.examine feet daily for scratches, cuts( A Simple Guide to Lacerations), blisters and corn


7.use a mirror to check the sole of your feet


8.Avoid going barefoot


9.Seek prompt treatment for cuts and sores


10.annual review for foot ulcers, risk of neuropathy (poor sensation), blood circulation( palpable pulses) 


General Measures: 


1.Smoking should be avoided as it causes constriction of the blood vessels


2.Avoid extreme temperatures such as excessive heat or cold


3.Home surgery should avoided in diabetes and those with vascular disease.
Avoid cutting calluses or corns yourself.
Also avoid applying strong chemicals to calluses or corn.
Instead try changing the weight bearing stresses on the foot.


4.When ulcers do appear they are most commonly on the weight bearing surface of the foot.
Vigorous local care such as removal of infected tissues and control of infections with antibiotics and antibiotic creams are indicated.
If the foot is warm and the blood flow good(feel pulse), healing of ulcers usually will occur.
Raise the foot and exercise the foot to improve blood circulation.


A diabetic patient of mine had an infected ulcer of the heel had to have daily toilet and dressing of the ulcer and antibiotics until the wound heals up. It took about 2 weeks for the ulcer to heal.
The next time he developed an infected ulcer of his sole, he went to the emergency department of the hospital where the surgeon on duty decided it was better to amputate his foot because he thought the infection may spread upwards his patient's leg.


5.Good balanced diet and a healthy lifestyle is important.