Patient Education

If you or a loved one experience difficulties due to wound management issues, the following information may be helpful to you:

Off-Loading Safety and Prevention for Diabetics
Safety Precautions for the Elderly Skin Care
Take Care of Your Feet Tips for foot Wear for Diabetics
Are You At Nutritional
Risk?
Your Doctor Says…You Have to Lower Your Cholesterol
Amputation Prevention Fact Sheet Charcot Joint Disease
General Foot Care Guidelines
Coping With Loss of Sensation
Dealing With Pain

Coping with Loss of Sensation

Your doctor has detected a critical loss of sensation in your feet.  This finding, referred to as neuropathy, means that your feet no longer have enough sensation to protect you from problems such as foot ulcers, serious infection, or a disfiguring joint dislocation called Charcot Joint.  Diabetes is the most common cause of neuropathy, but any disease process that causes nerve damage can also be a predisposing factor.

You may have noted changes in the sensations of pain and pressure in your feet already.  In time, pain and pressure may go undetected.  If pressure is constant, over time, oxygen and nutrients to the skin of your feet will be cut off.  This results in skin breakdown, or ulcer.  Ulcers usually occur on the walking surface of the foot, around the toe area, or anywhere bones are prominent.

Because you cannot depend on your sensation in your feet for protection, you must now use the sensation in your fingers, your eyesight, and a heightened awareness of prevention as substitutes.  These recommendations are meant to help you prevent the serious complications mentioned above.

What are the risk factors for developing neuropathic ulcers?

  • Poor foot care
  • Improperly fitting shoes
  • Hypertension
  • Smoking
  • Obesity
  • Trauma to the foot
  • Poorly controlled blood sugar
  • Bone deformities of the foot
  • Calluses, blisters, or reddened areas

What can you do to prevent neuropathic ulcers?
If your doctor has prescribed custom-made shoes:

  • Wear them at all times, including in the house
  • Do not substitute any other shoe without discussing it with your doctor
  • Keep in mind that for prescription shoes to have the best results, the entire shoe, or the special insole made for it, needs to be replaced periodically.  Have your doctor inspect your shoes regularly.
  • Always inspect the inside of your shoes with your hand for sharp or loose objects before putting on the shoe.

If you are still able to wear regular shoes:

  • Never wear new shoes longer than two hours at a time
  • After shoes are broken in, never wear one pair of shoes longer than five hours.  Use one pair for the morning hours, one pair for the afternoon hours, and one pair for the evening hours if at all possible.
  • Always inspect the inside of your shoes with your hand for sharp or loose objects before putting on the shoe.
  • Buy shoes made with soft leather uppers that are able to adapt to the shape of your foot.
  • Always have the shoe clerk properly fit the shoe to your foot when purchasing new shoes.
  • Let your doctor inspect your shoes, new or old, for fit and acceptability.
  • Buy new shoes at the end of the day when your foot is slightly larger.

Never go barefoot!  Not even in the house!

  • House shoes or house slippers, if allowed by your doctor, should have a thick enough sole to resist pin punctures or glass fragment punctures.
  • Avoid going barefoot in warmer weather around the pool or at the beach.
  • Wear socks with shoes at all times because they reduce friction, provide insulation, reduce soiling of the foot and absorb perspiration.
  • Do not wear socks with holes in them.
  • Avoid socks or stockings with seams.  
  • Wear socks made of cotton, wool or a blend – never a 100% synthetic material.
  • White socks are preferred because they can be removed, turned inside out, and inspected for signs of blood or pus at the end of the day.
  • Do not use garters or elastic bands to hold up your socks.  They can cause swelling of the legs and feet, or, worse, yet, serious circulation problems.

Avoid extreme temperatures:

  • Always check bath water with a thermometer or your hand before placing your feet in the water. 
  • Do not attempt to warm cold feet with a hot water bottle, heating pad, or next to a fire.
  • Beware of the car heater on excessively long trips.
  • Protect your feet from sunburn by using sunblock whenever you bathe. 
  • Snow skiing is a very high risk activity for your feet.  Be mindful of the cold exposure and any problems created by the ski boot.
  • Do not “ice down” your feet if they feel like they are burning

Avoid home surgery:

  • Never use a razor or other callus removing device.
  • Never use any chemical agent or medicated pad for the removal of corns, calluses, or warts.  These agents almost always contain an acid designed to erode the skin.
  • Avoid pads and arch supports bought over the counter.  Because they are not custom made for your foot, these devices can place excessive pressure on certain areas of the foot, leader to an ulcer.
  • Do not attempt to cut back the corners of your toenails.  It is better to use am emery board to file this area if the need arises.

Inspect your feet every night to catch problems early and prevent serious health conditions from arising.

  • You must be able to see and touch the following areas:  around the toenails, toes, between the toes, soles of the feet in the areas of the ball and heel.  You may need a mirror to help you.  If you can’t inspect your feet adequately, let your doctor know and ask a family member or friend to help you.
  • Look for blisters, cracks, redness swelling, discoloration or fluid drainage.
  • Feel with your fingertips for areas that seem warmer than areas next to them, or warmer than the same area on the other foot.
  • Report any of the above findings to your doctor immediately.
  • If you think you may have an infection, take your temperature and then you’re your doctor immediately.  Do not take any old antibiotics you may have in your medicine cabinet.