Diabetic Foot

Diabetes affects the whole body, but the eyes, heart, kidneys and feet are most at risk.

Body Clinic uses internationally defined standards such as screening frequency, goals, physical examinations and treatment protocols and foot care advice to patients founded on evidence–based clinical guidelines and present strategies in management and prevention as recommended by the International Consensus on the Diabetic Foot which is endorsed by the International Diabetes Federation.

This decreases variability in practice, reduces complications and improves quality of life.

There are 2 primary aspects of management of the Diabetic foot:
1. Prevention
2. Management

Prevention focuses on patient education in foot care and footwear, off–loading the deformed or insensate foot and re–perfusion if the arteries are affected by build up of atherosclerotic plaque. A series of non–invasive investigations are performed to establish a baseline and basis upon which risk of acquiring diabetic foot disease is assessed and subsequent to that a treatment plan can be devised to provide preventive treatment and therapies.

Management of acute wounds requires accurate diagnosis and choice of treatment plan, investigation for infection, application of the moist wound healing technique and prevention of recurrence.

Control of infection, pressure and perfusion are key in interrupting the pathways that lead to gangrene, necrosis, amputation, morbidity and mortality.

This is a highly skilled sub–specialty of podiatry and the company’s goal is to establish an acute diabetic foot clinic in association with a multi–disciplinary tertiary facility in Jakarta.

Studies show that where debridement and off–loading (podiatry services) and re–vascularization (by Vascular Physician) are included in a multi–disciplinary approach, there is a 73% long–term lower extremity salvage rate.

Looking after your Feet in 6 easy steps

  1. Look at your feet daily - you might need to use a mirror. 
    1. Look For :
      • Cuts
      • Cracks or breaks in the skin
      • Ingrown toenails
      • Corns
      • Blisters
      • Redness or swelling
      • Callus
      • Tinea
      • Thick nail plates
    2. If you have any of these problems you should see your podiatrist straight away
    3. NEVER use corn pads or plasters or strong antiseptics. See your podiatrist straight away
    4. NEVER attempt to treat corns, callous or ingrown toenails yourself
  2. NEVER go barefoot - not even in the house.
  3. Avoid heat
    1. Don't sit too close to an open fire or heater
    2. Only use an electric blanket on low - switch it off before going to bed
    3. Don't use a hot water bottle on your feet or legs
    4. NEVER walk barefoot on concrete or sand
  4. Choose properly fitting footwear
    1. Always buy shoes in the afternoon. Make sure they are properly fitting:
      • wide, deep toebox
      • long enough
    2. Features of appropriate footwear :
      • wide heel base
      • made of soft leather upper
      • no seems on the inside that rub on a pressure area
      • firm heel counter (back of shoe)
      • enclosed - preferably not sandals
      • leather, suede, elasticized upper (if hammer toes or deformities)
      • seemless leather inner
      • soft-soled - flexible rubber
      • low heel
      • lace-up or velcro closing
      • no tight spots
    3. Wear shoes in at the home for 20 hours before wearing them outside
    4. Make sure your shoes are in good condition, if not, replace them
  5. Treat injuries immediately
    1. Wash foot
    2. Pat dry
    3. Cover with non-adherent dressing fixed with tape from pharmacy
    4. Change dressing daily
  6. Visit your podiatrist at least annually :
    1. for examination of your neurovascular status
    2. chiropody/general treatment - debridement of corns and callous

Your podiatrist will liaise with your doctor and depending on your risk category for developing diabetic foot disease, he will give advice on the recommended frequency of visits.

If you are a smoker, we recommend you take steps to quit immediately.

Advice from your Podiatrist

  1. Nail cutting :
    1. Cut nails straight
    2. File off the corners
    3. Never cut down the sides
    4. Never cut the cuticles
  2. If you have dry feet :
    1. Nightly before bed, after washing and drying the feet, apply hand lotion to the hard skin areas of the feet
    2. Massage well into the skin
    3. DO NOT use in between the toes
    4. If putting on shoes after applying cream, wipe off excess so the foot is not slippery.
    5. Only use unperfumed creams e.g. Du’it, Nivea, Baby Lotion, Neutrogena, diabetic specialty products
  3. If you have sweaty feet :
    1. After washing feet with soap and water, dry well especially between the toes
    2. Apply either an alcohol wipe (available from your pharmacy) or use surgical spirit on a cottom wool ball
    3. Change socks & footwear at least 2 times per day
  4. If you have interdigital maceration :
    1. After washing your feet (shower, bath, swimming or for prayer), dry between the toes with a clean towel.
    2. Apply either an alcohol wipe (available from your pharmacy) or use surgical spirit on a cottom wool ball
    3. DO NOT use creams or talcum powders between your toes unless advised by the Podiatrist to do so.
    4. Never cut the cuticles
  5. If you are being treated for an ulcer your Podiatrist may advise the following between visits to the clinic :
    1. Wash your foot/feet in a clean bowl with warm (DO NOT USE HOT WATER) salt water (2 teaspoons of salt to 2 liters water) or soapy water (2 squirts of liquid soap or use a bar of soap until the water is soapy)
    2. Pat dry the feet thoroughly with a clean towel especially between the toes