Foot care is essential for patients with diabetes

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With appropriate knowledge, they can perform self-examinations and adhere to clinical examinations.

Pharmacists are no stranger to the increasing prevalence of diabetes, but many are unaware that 15% to 25% of patients develop foot complications. They should therefore keep several points in mind when offering advice.1

Diabetic foot ulcers, infections

Because diabetic neuropathy tends to develop in these patients, they lose pedal sensation. Diabetic foot ulcers are open sores usually located on the bottom of the foot as a result of foot deformities, irritation, and poor circulation.2.3 When any of these risk factors exist, patients should manage their foot care consistently through self-examination and quarterly clinical reviews.

Patients can prevent further diabetes complications. High blood sugar levels, common in diabetic patients, can prevent foot ulcers from healing, leading to diabetic foot infections. These infections, defined as an infection of the soft tissues or bones below the malleolus (the protuberance on both sides of the ankle joint), are classified as mild, moderate or severe.4 If cuts and scrapes are left untreated, life-threatening infections are possible. More importantly, a diabetic foot infection is the most common cause of lower extremity amputation associated with diabetes.3.4 Prescribers can use antibiotics to treat mild infections. However, as the severity of the infection increases, so does the severity of the procedure.4

Preventive care

Proper debridement can prevent foot ulcers from turning into serious infections.2 Because diabetic patients have a greater risk of complications leading to higher healthcare costs, prevention is the main key to diabetic foot care. The American Diabetes Association (ADA) and CDC recommendations on foot screening and foot hygiene education parallel each other.5 The ADA has also compiled a 0-3 diabetic foot risk classification with recommendations and follow-up care.5 Table 15 presents the ADA recommendations based on hazard classification.

The National Institute of Diabetes and Digestive and Kidney Diseases suggests that a diabetes care plan that includes a podiatrist is vital for patient health.6.7 Table 28 provides examples of points of advice that pharmacists should communicate to all patients.

Diabetic Foot Infection Treatment Recommendations

Patients with foot-related problems often seek help from pharmacists. It is important to understand the steps necessary to ensure patient health and safety.

TBT Recommendations

The formation of calluses and corns is common in people with diabetes. Salicylic acid is a widely available over-the-counter product that is helpful in treating them, but diabetic patients should not self-medicate. Instead, they can be soaked in lukewarm water for about 5 minutes to soften dead tissue for gentle removal.8 If patients are looking for pain relief, pharmacists may recommend the use of cushioning pads in shoes to relieve pressure.8 Self-treatment guidelines
for ingrown toenails also exclude patients with diabetes. Pharmacists can offer advice on proper nail trimming to prevent ingrown toenails and ensure patients see a podiatrist regularly.8

Prescribing recommendations

Initial antibiotic regimens for foot infections are empirical.4.9 Once cultures from the infected wound are available, providers can streamline treatment. For mild infections, amoxicillin-clavulanic acid and cephalexin are acceptable options.9 In the early 2000s, the FDA approved ertapenem, linezolid, and piperacillin-tazobactam for the treatment of complicated diabetic foot infections.9 Although the duration of treatment is based on severity, most patient infections resolve within 1 to 2 weeks. Infections associated with osteomyelitis generally require 4 to 6 weeks of treatment. Serious diabetic foot infections require surgery. The Infectious Diseases Society of America (IDSA) recommends that patients with diabetes receive wound care, including debridement, pressure redistribution, and wound dressing.9 IDSA guidelines emphasize that diabetic foot care teams should include a clinical microbiology specialist, an infectious disease specialist and a surgeon.9

Patients taking antibiotics may have digestive problems, such as loss of appetite, nausea, and vomiting. Pharmacists should advise patients to avoid alcohol, take medications as directed, and use probiotics.ten Pharmacists have a responsibility to encourage patient adherence throughout treatment to prevent recurrence of infection.

Conclusion

Foot care is extremely important for all patients with diabetes. One of the main enablers of diabetic foot care is patient education. With the appropriate knowledge, patients can perform self-examinations and adhere to their clinical examinations. Pharmacists play a central role in this process and can successfully promote positive preventive care practices.

About the Author

Karisse Lora is a Pharmacy candidate at the University of Connecticut School of Pharmacy at Storrs.

References

1. Yazdanpanah L, Shahbazian H, Nazari I, et al. Diabetic foot ulcer incidence and risk factors: a population-based diabetic foot cohort (ADFC study) – two-year follow-up study. Int J Endocrinol. 2018;2018:7631659. doi:10.1155/2018/7631659

2. Frequently asked questions: diabetic foot ulcers. University of Michigan Health. Accessed July 11, 2022. https://www.uofmhealth.org/conditions-treatments/podiatry-foot-care/frequently-asked-questions-diabetic-foot-ulcers

3. Bandyk DF. The diabetic foot: physiopathology, evaluation and treatment. Semin Vasc Surg. 2018;31(2-4):43-48. doi:10.1053/j.semvascsurg.2019.02.001

4. Gemechu FW, Seemant F, Curley CA. Diabetic foot infections. Am Fam Physician. 2013;88(3):177-184.

5. Boulton AJM, Armstrong DG, Kirsner RS, et al. Diagnosis and management of diabetic foot complications. American Diabetes Association; 2018.

6. Song K, Chambers AR. Diabetic foot care. In: StatPearls. StatPearls Edition; May 1, 2022.

7. Diabetes and your feet. CDC. Updated May 7, 2021. Accessed July 11, 2022. https://www.cdc.gov/diabetes/library/features/healthy-feet.html

8.Srivasta SB. Minor foot problems. In: Berardi RR, ed. Handbook of over-the-counter medications: an interactive approach to self-care. 20th ed. American Association of Pharmacists; 2009.

9. Lipsky BA, Berendt AR, Cornia PB, et al; American Society for Infectious Diseases. Infectious Diseases Society of America 2012 clinical practice guidelines for the diagnosis and treatment of diabetic foot infections. Blink Infect Dis. 2012;54(12):e132-e173. doi:10.1093/cid/cis346

10. How to reduce the side effects of antibiotics. UPMC HealthBeat. January 8, 2016. Accessed July 11, 2022. https://share.upmc.com/2016/01/how-to-reduce-side-effects-of-antibiotics/

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