Published information from many countries of the world testifies to the high prevalence of diabetic foot disease in residents of care homes (Sinclair et al 1997b; Cantelon 1972; Mooradian et al 1988; Wolffenbuttel et al 1991). The risk of foot ulceration is increased in those with advancing age, loss of protective pain sensation due to diabetic peripheral neuropathy, peripheral vascular disease, and bony foot abnormalities (Gadsby and Mclnnes 1998).
The residents in some homes have access to free care from state registered podiatrists, whilst in other homes private podiatrists are employed, when residents may have to pay fees for footcare. In some care homes there is no structured plan for footcare. Where available, a local state registered podiatrist with an interest in diabetes is a very important member of the district multidisciplinary diabetes team, and his or her skills need to be utilized by care home staff in appropriate ways.
All people with diabetes should have a foot examination yearly as part of the review process, and residents in care homes are not exempt from this recommendation (BDA 1997). This examination is to detect feet at risk of ulceration. At its simplest this involves a brief history to discover any previous episodes of ulceration, inspection of the feet to check for bony abnormalities, palpation of the dorsalis pedis and posterior tibial pulses to detect ischaemia, and use of the 5.07 g nylon monofilament to detect loss of protective pain sensation. This foot examination can be done by any member of the community diabetes team who has the relevant skills and experience. If the foot is deemed to be at risk it should be checked every 3 months by a podiatrist, and extra foot education given (Gadsby and Mclnnes 1998).
It is also important to train care home staff to understand the importance of preventive footcare, and to alert them to the importance of detecting early signs of foot ulceration and/or infection so that urgent prompt referral and action can be taken. The local state registered podiatrist with an interest in diabetes will usually be the best person to provide this help.
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