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Good Foot Care – Keeping Your Diabetic Neuropathy Patients Healthy

Help Diabetics with Better Care

 

Diabetes is one of the fastest growing illnesses in America.

That means that if you don’t currently have patients with diabetes (unlikely, but possible), you will soon.

And that means you’re going to be treating patients with diabetic neuropathy, particularly in their feet.  According to the American Diabetes Association, one in five diabetes patients end up in the hospital with foot problems.  All too often those foot problems lead to amputation or raging systemic infections.

The best way to prevent these problems in your diabetic neuropathy patients is by educating them on how important it is to take care of their feet and to intervene as early as possible when they do develop problems.  Determine the extent of your diabetic neuropathy patient’s problems and then educate them on proper foot and diabetes care.

Step One  – The Thorough Foot Examination[1]

If you have patients with diabetic neuropathy, even if they don’t present with foot issues, you need to be proactive as their physician and ensure that you see them at least once a year for a complete foot examination.

When you’re examining their feet, make sure you:

•         Examine each foot between the toes and from toe to heel.  Make extensive notes in the chart of any problems by drawing or labeling the finding on the foot diagram.   If your patient has skin that is thin, fragile, shiny and hairless, they could have problems with their circulation and that means possible nerve damage.

•         Ask the patient if they’ve noticed any change in how their feet sweat.  If their feet don’t sweat as they normally would they can develop dry, cracked skin and those cracks can become infected.

•         If your patient is wearing nail polish, take it off.  Check for ingrown toenails, deformed nails or any type of nail fungus.

•         Make notes on the diagram and in the chart of any areas on the feet that are noticeably dry, red or warm to the touch.

Step Two  – Patient Education

In order to prevent serious problems, your diabetic neuropathy patients need to know how to care for their feet and what to watch for so they can come in to see you before they reach a point  of no return.

They need to:

•         Check their feet every day.  Look at their bare feet to make sure they don’t have any sores, blisters, or swelling.  If they can’t see the bottoms of their feet, they should use a mirror or ask someone else to check them.

•         Wash their feet every day and dry them completely to eliminate the possibility of fungus growth.

•         Use a good lotion on their feet to keep skin smooth and prevent dry, cracked skin.  Don’t use lotion between the toes – it will keep the skin there too moist and that breeds bacteria.

•         Trim their toenails but not too short.  Cut them straight across and file the edges with a nail file to prevent ingrown toenails.

•         Always wear shoes and socks – even inside the house.  If they have neuropathy, it’s just too easy to step on something and injure their feet without even feeling it.

•         Wear comfortable shoes, preferable shoes designed for people with diabetic neuropathy in their feet.  Check their shoes before they put them on and make sure the lining is intact and smooth and that nothing is in their shoes.  Talk to them about Medicare assistance with purchasing special shoes.

•         Never put their feet in hot water.  Always check the temperature of their bath water with the elbow before stepping into it.

•         Never use hot water bottles or heating pads on their feet.  Neuropathy makes it harder to sense extreme temperatures and they can burn their feet without even knowing it.

•         When sitting down, they should prop their feet up to keep the blood circulating.  Move the toes and ankles to keep the blood pumping.

•         Never cross their legs when sitting.

Don’t just tell them what they need to do and take it for granted that they understand what you’re telling them.  Ask your patient to demonstrate the steps to proper foot care so you know they know what you’re saying and that they are physically capable of doing what you’re telling them to do.

Offer your diabetic neuropathy patients an ongoing monitoring and follow up program.  Keep in touch and watch for any of the symptoms of diabetic neuropathy in the feet.   Diabetic neuropathy impairs the ability to feel pain in the extremities and they may not notice the problem until it’s too late for successful treatment.  It never hurts to have a fresh pair of eyes (yours) keeping watch over them.

When you’re trained and ready to treat them, let us help you reach them.

For more tips on growing a successful chiropractic, physical therapy or pain management practice, log on to http://perfectpractice web.com to download a FREE E-Book Copy of my 5 star Amazon  “Living and Practicing by Design” at http://perfectpracticeweb.com.

 

Osteoporosis, Kyphoscoliosis in an 80 Y.O. Lady

An 80 Year Old lady with chronic T Spine Pain,
marked osteoporosis, kyphoscoliosis,
post kyphoplasty X2 is referred by her PCP
for evaluation and treatment.

Which tests do you order or make sure
were done? What are some possible Txs?

Managing LS Facet Arthritis

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Clinicians Corner

John is 48 years old. He has a very long history of Low Back Pain.

He says he had Chiropractic care for about 6 weeks 10 years ago, with no lasting relief. He wants to try a new appraoch, and heard we do things “different”. He wants to avoid Surgey and Epidural Blocks.

His medical Hx is significant for excission of basal cell skin cancer.
He is not diabetic.
He takes NSAIDS, only when very acute. Family Hx is positive for LBP, disabling in 2 siblings.

His exam is remarkable for a paucity of findings. Stiff ROMS, no root signs, extension is very uncomfortable.

Plain Films show very marked facet disease at L5-S1. Lets assume for this discussion his primary Dx is severe facet joint DJD.

Whats are rational Tx plans, expectations and reasoable goals to tell John on Case Review Day? How would you substantiate the need for care beyond the initial stages?

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August 2008 Survey Responses

Thank you for responding to our recent Aug 2008 survey. Here are the unfiltered results. Watch your weekly emails for details and new products and services!

3/5ths of Respondents were non-members.

1. What is your biggest concern in practice building in this current environment?

The overwhelming number of doctors still struggle with all NP issues.
Acquisition, case acceptance, etc.[Pease read my article below!]

2. What types of services are you most inclined to actually purchase?
Audio CDs by 60%, mp3s, and teleseminars were the remaining choices.

3. What is the single most important factor when considering theses services?
Ease of Use, cost, content all scored as equally important.

4. Which delivery method is best for free content?

Email 100%

5. Which is your number-one preference for paid content?

Doctors are 50% Split audio CD and mp3

6. What topics would you like to see in the next year from our company?
Patient retention and getting new patients in the door with little cost.

Treatment algorithms
MD marketing, JD marketing, insurance compliance topics,
Chiropractic diagnosis/technique

7. Given a choice, what is your most current favorite PAID way to learn new information?
Web Based and Live Events were split 50%.

8. MEMBERS ONLY: How can we best improve our services and programs?

One of the best, most helpful responses: integrate new topics to educate
Members better in today’s environment –

Examples would be a new diagnostic skill to use or a new marketing program
To implement.

9. NON MEMBERS: What is your biggest hesitancy about becoming a (DC) member?
Cost was #1 answer. ( Drs, are you aware of our Silver Steps Memberships?)

10. Would you be more inclined to use a teleseminar based membership service if an audio CD and Transcript were provided afterwards?

Yes 100% of the time!