Wound Management – Prevention is Better than Cure

In our new Wound Management course, the focus is firmly on chronic wounds and with good reason. Venous, arterial, pressure and diabetic foot ulcers cost the NHS over £4 billion and are a source of pain and debilitation for at least 200,000 patients each year. ⁽¹⁾ It’s crucial that we use up-to-date, research-based methods and products when treating these wounds but the importance of preventing their development in the first place should not be underestimated.

With this in mind, Diabetes UK launched their campaign Putting Feet First. It’s been highly successful in raising awareness of diabetic foot ulcers and has been credited with increasing the number of specialist foot care teams available in the NHS. But foot care should be routine for people living with diabetes and so, for the nurses and healthcare assistants in the community and social care, foot inspections should be part of their arsenal against diabetic ulcers.

Why does diabetes make people more susceptible to foot ulcers?

There are almost 3.7 million people living with diabetes in the UK and due to lifestyle changes, this figure is set to rise. The raised blood glucose levels that diabetics can experience, cause damage to blood vessels and if this happens in the retina, kidneys and peripheral nerves, it may eventually lead to blindness, kidney failure or neuropathy. In addition, high blood sugars also hinder the normal immune system response, making infections more likely and difficult to fight.

Now, imagine you have a tiny stone in your shoe. You take a few steps, wince, kick your foot about to try and shift it and when that fails, take your shoe off and shake the stone out. Problem solved!

But if you have neuropathy with reduced sensation in your feet, you walk about all day and don’t even realise the stone is there. But it is there and after a day of continuous pressure, the skin has broken and you now have a small wound. Because of the damaged blood vessels, you may also have poor circulation, so the oxygen and nutrients needed to heal the wound can’t get there easily and the high blood sugars mean that infections can quickly establish themselves.

The catalogue of diabetes-related effects has led to a foot ulcer and 1 in every 10 people with diabetes will suffer this at some point in their life. The problems don’t just end with a painful and distressing wound though. Having toes, part of the foot or the lower leg amputated is a significant risk, once a chronic ulcer has developed. However, foot ulcers don’t have to be an inevitable part of diabetes.

Making the Most of Inspections

With the appropriate training, foot inspections should become a daily routine for those looking after people with diabetes. Ideally, it should take place after a bath or shower, making sure that the feet are clean and dry.

It starts with checking the skin of the entire feet, even between the toes, and lower legs but what are the key areas to look out for?

• Condition or signs of damage Dry, cracked skin and calluses are often how ulcers start, as they can provide an entry point for infections.
• Colour changes Redness can indicate that an infection is present whereas a pale or blue colour can mean that there’s a problem with the circulation.
• Texture Shiny or thin skin and a loss of hair growth can also be caused by a poor blood supply.
• Toenails Length, thickness, colour, separation from the nail bed, debris or puffy, red skin surrounding the nail should be documented and monitored. If the toenails are thought to be a potential source of damage, specialist podiatry treatment can be arranged.
• Temperature  Normally, the shin is warmer than the toes and any deviation from the norm could indicate infection, vascular impairment or neuropathy.
• Foot pulses Palpate both foot pulses and if they can’t be felt, report this so it can be investigated further. Vascular sufficiency can also be checked by pressing and blanching the toe pulp. If reperfusion takes longer than 5 seconds, this should act as an alarm bell.

Ensuring that feet inspections are part of the daily routine will help healthcare professionals in the community and social care to confidently spot changes and, seeing as early recognition can make all the difference in stopping minor skin problems becoming chronic wounds, and that’s good news for everyone.

1. Bowen G, Richardson N (2016) Biofilm management in chronic wounds and diabetic foot ulcers. The Diabetic Foot Journal 19: 198–204

If you’d like to find out more about Relias’ Wound Management training and how our learning management system can ensure your staff are delivering the highest quality care, request a conversation with a member of our team.