Q 1) How can foot care be best
achieved by both patients with diabetes and
healthcare
professionals?
A1) There are quite a few cornerstones of diabetic foot care such as
checking one's feet
daily for a change in colour, callous or wounds or a change in
structure of the foot. If you
find a break in the skin, it is to be addressed as soon as possible.
Wear good shoes that follow guidelines outlined by one's health care provider (a bad
shoe may be as
dangerous as walking barefoot).
All these may be easily achieved if the
patient has a more positive attitude towards
his/her illness and plays an active role in looking after
himself/herself. Diabetic foot care
is very easy and does not take up much time but it needs to be
regular (daily) and
consistent in order for it to be effective.
The health care provider needs to ensure that the person goes for
his/her regular check- ups and is advised on how to look after his/her feet. Health care
providers should focus
on encouraging, supporting and educating patients rather than
consistently focusing on
negative aspects of a patient's self-management.
Q2) Could you elaborate on the common
problems of diabetic foot care in
Singapore?
What can patients and healthcare professionals do to overcome
these
problems?
A2) Singapore is a humid country and due to the heat the types of
shoes worn here are often
chosen more to suit the climate rather than the diabetic foot. For
example, it is common
for no shoes to be worn inside the home as well as bad footwear
(e.g. thonged slippers)
to be worn outside.
Furthermore, it is uncommon for many patients to regularly wash, dry
and inspect their
feet on a daily basis. The use of reflexology stones or going
barefoot on the hot floors
outside is a common occurrence that may be dangerous to some
patients who have
reduced sensitivity/ neuropathy. Such patients have decreased
sensation in their feet due to their diabetes and thus may injure themselves on the stones
or burn themselves
on the hot floors, yet they are unable to feel this and as a result
continue to partake in
these activities. Consequently, serious damage may occur to the feet
which the patient
himself/ herself may not even be aware of.
Educating diabetics on diabetic foot care and outlining the
consequences of incorrect
care is essential in overcoming some of the aforementioned problems.
One such consequence is the effect that injury to a patient's foot, or even
amputation of a lower
limb, affects the whole of the family as it involves medical bills,
close supervision/care for
the patient by family members, etc.
In Singapore, there are only 17 Podiatrists and a handful of
diabetic foot care nurses. However, there are approximately 300,000 diabetics. Consequently, it
is difficult for all
diabetics to be assessed properly and on a regular basis. An
increase in the number of
podiatrists would help overcome this problem.
Q3) What are the dangers of self-treatment
for peripheral neuropathy and diabetic
foot
ulcers in general? What can
patients do to save themselves from further
complications if
these dangers have already happened?
A3) One complication of diabetes is peripheral neuropathy or damage
to the nerves that
sense pain, touch and temperature. Diabetics with neuropathy do not
feel pain when they hurt their foot and thus may injure their foot unknowingly.
Such injury may occur with
self-treatment (e.g. inadvertent cuts with nail clippers or injuries
due to attempting to
treat ulcers or ingrown toenails with pen knives etc) and may easily
become infected
due to the use of non-sterile instruments. The infection can spread
very rapidly if you are
not aware of it (due to lack of sensation) or if you have poor blood
circulation both of
which are very common in diabetics. Delay in treatment of foot
infections may lead to
surgical cleaning of the wound, foot or even an entire leg
amputation.
Furthermore, many people apply the wrong medication onto their
wounds/ulcers which
may result in more damage. One of the most important complications
that results from
self-treatment is that it leads to a delay in seeking appropriate
treatment from a qualified
health care professional. Consequently, a wound may already be
gangrenous or
severely infected by the time the patient seeks treatment.
Q4) What are the milestones achieved in the
Podiatry Association (S)'s
collaboration with
the Ministry of
Health and Health Promotion Board to increase public awareness in
podiatry?
A4) The MOH and HPB have been actively promoting podiatry as a
health care profession
within Singapore amongst both the general public and medical
professionals. Podiatrists taking part in seminars and contributing to various
publications which are
distributed to the public and to medical professionals help raise
awareness of the
scope of our profession within Singapore.
Q5) This year's WDD theme is: Put Feet
First, Prevent Amputations. In your view, what efforts
have the Podiatry Association (S) made to achieve this objective?
A5) The Association members have been making an ongoing effort to
achieve the aim of
preventing amputations in the diabetic foot. This has been addressed
via a number of
different avenues including:
-
an
increased awareness of appropriate foot care via media formats
including interviews, printed articles, seminars, workshops and
media appearances (TV, radio) both in Singapore and around the
region
-
training diabetic foot care nurses in Singapore who are then able
to help assess and educate diabetics in the primary health care
system
-
conducting voluntary foot assessments and screening
-
In
the hospital system, our members are part of multidisciplinary
diabetic foot care teams and as such have helped with the
establishment of the Lower Extremity Amputation Prevention program
-
The
Podiatry Association (S)'s contribution to the publication
"Clinical Guidelines to the Diabetic Foot" which is distributed to
medical professionals within Singapore.
Q6) Could you elaborate on the
latest global developments in diabetic foot care
management? How far have Singapore's podiatrists and healthcare
specialists involved in
diabetic foot screenings kept up with these developments?
A6) Podiatry Association(S) members regularly attend international
conferences to upgrade
their knowledge of recent advances in the field of podiatric
medicine including diabetic foot care management. For instance, the recent adoption of
multidisciplinary teams in
the local hospital system.
Another example includes risk
identification which is fundamental for effective preventive
management of the foot in people with diabetes. It is currently
being implemented in all
the hospital podiatry units. There are two types of risk
identification.
The first one is where there are four risk
categories based on sensation status to the
5.07(10g) monofilament, the presence of foot deformity, and a
history of lower-extremity vents (amputation or ulceration): category 0, sensate; category
1,
insensate; category 2, insensate with deformity; and category 3, history of lower extremity
events.
The second identification process is a colour coded one where one
goes from stage 1(green) which is normal foot to stage 2 (yellow) high risk foot,
then stage 3 (orange)
ulcerated foot, stage 4 (red) cellulitc foot, stage 5 (magenta)
necrotic foot and finally,
stage 6 (purple) which is amputation. The first one is currently the
most widely used.
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