Presentation on theme: "*The Noble Foot* Standing on a Firm Foundation"— Presentation transcript:
1*The Noble Foot* Standing on a Firm Foundation Shawneen Schmitt, RN MSN MS CWOCN CFCNWebsite PresentationforWOCN – NCR
2This is to inform you that there is no endorsement of any products used in this presentation. It is used for educational purposes only.There is no conflict of interest present.This presentation is not to be duplicated unless written consent is given by the author.
3Presentation Outcomes The participant will be able to:Describe the A&P of the foot & nailIdentify health care challenges related to the foot & nailsSynthesize the assessment process for foot and nailsCreate a plan that reflects the appropriate standards for foot & nail care practice
4People’s feet come in different shapes, sizes, colors and have taken many paths to accomplish so much in a lifetime
15Normal Aging of the Foot Decrease in circulation with increase in vessel calcification especially due to diabetes and arteriosclerosisReduction in joint movementDecrease in skin moistureReduction in fat pad thickness over bony prominencesLoss of sensory cellsChanges in foot structures
16Contributing Factors for Foot Disorders Peripheral Vascular DiseaseArterialVenousDiabetesArthritisOsteoporosis/OsteomyelitisFractures/TraumaCentral Nervous System DysfunctionDeformities
17Symptoms Related to Changes in the Foot’s Shape Pain when wearing shoesPain when weight bearing such as walkingDevelopment of corns and callous and ingrown toenailsInability to find appropriate fitting shoesIncrease in aching jointsIntensify development of bunions, claw and hammer toesEnhancing of flat or cavus (high arch) foot formation
21Interesting Nail Facts Nails grow approximately 0.1 mm per day or 3 mm per month.Nails grow faster in daytime and summer.Fever and serious illness slow growth rates.Pregnancy enhances growth.Nails grow more rapidly in men and younger people thanin women and the elderly.Toenails grow 1⁄2 to 1⁄3 the rate of fingernailsKechiijian P. How do nails grow? Nails. May 1993:78 –79.
22Finger and Toe Nails Can Tell a Story of a Person’s Health
25Foot Inspection/Assessment Check the condition of the skinIntactDry and crackedMoist and maceratedRash/fungusRed/inflamedWarm or coolOdorDetermine capillary refill < 3secCheck for edemaCheck for presence of hairFat pads over bony areasStance and gaitAny painDescriptionProblemsCallousCornsBlistersDeformities
36Evidence Based Practice and Quality Assurance Educating diabetics about foot care has proven helpful in reducing foot ulcers and amputations, particularly in high risk patients. Nevertheless, studies have shown that diabetic patients are not offered adequate foot care. In one study examining several aspects of foot care in patients with diabetes, 28% of patients reported that they had not received foot education from their physician. Moreover, the presence of risk factors for lower limb complications was not associated with a greater chance of receiving foot education. The same study noted that patients who had received foot education and had their feet examined by their physician were more likely to perform self inspection. When combined with a comprehensive approach to preventive foot care, patient education can reduce the frequency and morbidity of limb threatening diabetic foot lesions."American Society for Plastic Surgeons (ASPS), Physician Consortium for Performance Improvement®, National Committee for Quality Assurance (NCQA). Chronic wound care physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2008 Aug. 35 p. [19 references]
37Evidence Based Practice and Quality Assurance Educate the patient about the importance of optimizing glycemic control, using appropriate footwear at all times, avoiding foot trauma, performing daily self-examination of the feet, and reporting any changes to health care professionals. (Lipsky et al., Infectious Diseases Society of America [IDSA], 2004)Patient and family education assumes a primary role in prevention. Diabetic patients at risk for foot lesions must be educated about risk factors and the importance of foot care, including the need for self-inspection and surveillance, monitoring foot temperatures, appropriate daily foot hygiene, use of proper footwear, good diabetes control, and prompt recognition and professional treatment of newly discovered lesions. (Frykberg et al., American College of Foot and Ankle Surgeons [ACFAS], 2006)Good foot care and daily inspection of the feet will reduce the recurrence of diabetic ulceration. (Wound Healing Society [WHS], 2006)
40Safe Nail Care Implements Things to AvoidSafe Nail Care Implementsfor the Patient
41Nail Care IndicatorsConsider professional care when an individual has:Poor or no eyesight (glaucoma, macular degeneration)Unable to reach feet (obesity, arthritis )Impaired circulation the “at risk” person (diabetic neuropathy, PVD)Unable to use equipment safely (CVA)Abnormal nails (thick, fungal)No significant person to help with care
42Nail Care TechniqueThe nail should be cut on a marginal curve or follow the natural nail curve/shape NOT straight acrossThe nail should not be cut in one piece but in small sections or nipsAfter cutting, the nail should then be filed in one direction until smoothThen check between toes to remove any nail debrisFinally, apply a thick lotion/cream to foot to re-moisturize the skin and cuticles but do not apply between the toes.
43Reflexology Foot Massage is an alternative medicine method involving the practice of massaging or applying pressure to parts of the feetIs used for relaxation and increase localized blood flow
53Goals for Quality for Wound Healing Utilize evidence based standard practicesProvide pain reliefApply appropriate dressings/therapiesUse a collaborative approachAdequate nutritionPatient “buy-in”Lifestyle changesEducationTime enhancementMoisture managementStage/diagnose accuratelyMonitor closelyDetermine cause of chronicityInfection controlDebride appropriatelyOff-load/pressure relief
54Evidence Based Practice and Quality Assurance A moist wound environment is essential to accelerate wound healing. Nevertheless, "wet to dry and gauze dressings are the most widely used primary dressing material in the United States" and evidence suggests that they are used inappropriately. In a recent study examining wound care practices, the use of dressings to maintain moist wound conditions ranged from 41.7% to 58.5% for diabetic and venous ulcers, respectively. Wet-to-dry dressings should not be utilized in the care of patients with chronic wounds as they may actually impede healing and are associated with an increased risk of infection, prolonged inflammation, and increased patient discomfort.American Society for Plastic Surgeons (ASPS), Physician Consortium for Performance Improvement®, National Committee for Quality Assurance (NCQA). Chronic wound care physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2008 Aug. 35 p. [19 references]
55Evidence Based Practice and Quality Assurance Use clinical judgment to select a wound dressing that facilitates continued moisture. Wet-to-dry dressings are not considered continuously moist. Continuously moist saline gauze dressings are as effective as other types of moist wound healing in terms of healing rate, although they may have other drawbacks such as maceration of the peri-ulcer skin, practicality of use, and cost effectiveness. It can also be very difficult, practically, to keep gauze dressings continuously moist.(Wound Healing Society [WHS], 2006)
61Principles of Orthotic Management RedistributionAccommodationStabilizationCompensationRestImmobilizationContainment
62Evidence Based Practice and Quality Assurance Offloading is a mainstay in the prevention and treatment of diabetic foot ulcers. Despite its importance in the care of patients with diabetic foot ulcers, a recent study examining wound care practices found that approximately 23% of patients with diabetic ulcers had no documentation of offloading devices.American Society for Plastic Surgeons (ASPS), Physician Consortium for Performance Improvement®, National Committee for Quality Assurance (NCQA). Chronic wound care physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2008 Aug. 35 p. [19 references]Relieving pressure on the diabetic wound is necessary to maximize healing potential. Acceptable methods of offloading include crutches, walkers, wheelchairs, custom shoes, depth shoes, shoe modifications, custom inserts, custom relief orthotic walkers (CROW), diabetic boots, forefoot and heel relief shoes, and total contact casts. (Wound Healing Society [WHS], 2006)
67Medicare Coverage for Special Footwear Usually covered under Medicare Part BNeed a physician/podiatrist prescriptionIf you qualify, entitled toOne pair of depth shoes (athletic or walking shoes with a higher toe box)Up to three shoe inserts OROne pair of custom-molded shoes and two additional insertsWill need to pay approximately 20% of the total
68FYI - Documentation and Medicare With the increasing costs and services associated with debridement and the potential overuse of these procedures, documenting the wound characteristics prior to debridement is important to confirm the medical necessity of the procedure. A review of surgical debridement services billed to Medicare in 2004, by the Office of the Inspector General, found that 29% of services had no documentation or insufficient documentation to determine whether the services were medically necessary or were coded accurately. Another important purpose of assessing and documenting the characteristics of the wound is to monitor wound progress and subsequently evaluate the treatment regimen and make any necessary adjustments.American Society for Plastic Surgeons (ASPS), Physician Consortium for Performance Improvement®, National Committee for Quality Assurance (NCQA). Chronic wound care physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2008 Aug. 35 p. [19 references]
70On behalf of all the unique and beautiful feet in the world… On behalf of all the unique and beautiful feet in the world….I thank you!
71References/Resources Alavi, A., Woo, K., Sibbald, R. G. (2007). Common Nail Disorders and Fungal Infections. Advances in Skin & Wound Care. 20(6):Baranoski, S. and Ayello, E. (2004). Wound Care Essentials, Practice Principles. Philadelphia; Lippincott, Williams & WilkinsEdmonds, M., Foster, A., and Sanders, L. (2004). A Practical Manual of Diabetic Foot Care. Malden, MA. Blackwell Publishing.Sussman C. (1999) Wound Care: Patient Education Resource Manual. Gaithersburg, MD, Aspen Publishers Inc.Turner, W. and Merriman, L. (1997). Clinical Skills in Treating the Foot. St. Louis; Elsevier.Westley, C. and Glick, D. (1997). Foot Care: An Innovative Nursing Service in a Community Nursing Center, Journal of Community Health Nursing. 14(1):15-21.