T2 · Foot problems in diabetes
Risk Long-term illness
Definition
Reduced feeling and blood flow raise the chance of ulcers and infection.- Nerve damage
- poor circulation
- poor foot care
- ill-fitting shoes
- Numb feet
- ulcers
- calluses
- slow healing
📋 Scenario
A diabetic with numb feet wears tight shoes and has dry, cracked heels.
Subjective (S): "I cannot feel my feet."
Objective (O): Numb feet; dry cracked heels; tight shoes; weak foot pulses; no ulcer or open skin; blood sugar 14 mmol/L.
Assessment tools for this scenario: CP-LONG Long-Term Condition Check CP-SKIN Skin & Wound Score CP-FLUID Fluid Balance & Nutrition Score
Validated scales to consider: Self-management review, Braden Scale, TIME wound chart, MUST, fluid chart, glucose
**CarePath diagnosis:** Foot problems in diabetes related to nerve damage and poor foot care (risk factors); no signs of the problem are present yet.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Check feet daily. | Numb feet cannot sense injury, so daily inspection finds cuts, blisters and pressure marks early, before they become ulcers or infections. |
| Use proper shoes. | Tight or poorly fitting shoes rub and press on numb skin and cause sores. Well-fitting protective shoes spread pressure and prevent damage. |
| Keep feet clean and dry. | Moist skin between the toes encourages fungal infection, and dry cracked heels allow germs in. Clean, dry and moisturized skin keeps the barrier intact. |
| Refer to podiatry. | A podiatrist can assess nerve and blood flow, treat calluses and advise on footwear, which lowers the chance of ulcers in a high-risk foot. |
| Control sugar. | High blood sugar damages nerves and blood vessels and slows healing. Better control lowers the risk of further nerve damage and infection. |
**Expected outcomes**
- No ulcer or open skin develops.
- No infection.
- Daily foot checks.
- Proper shoes.
**Linking the data to the diagnosis**
This is a risk diagnosis because there is no ulcer yet. The patient has numb feet, says, "I cannot feel my feet," and has dry cracked heels, tight shoes, weak foot pulses and a blood sugar of 14 mmol/L. There is no open skin, so an actual foot ulcer diagnosis would be wrong; nerve damage and poor foot care are the risk factors. The plan protects the skin and improves control of sugar. The aim is no infection, daily foot checks and proper shoes.
CarePath diagnosis
Foot problems in diabetes related to nerve damage and poor foot care (risk factors); no signs of the problem are present yet.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Check feet daily. | Numb feet cannot sense injury, so daily inspection finds cuts, blisters and pressure marks early, before they become ulcers or infections. |
| 2. Use proper shoes. | Tight or poorly fitting shoes rub and press on numb skin and cause sores. Well-fitting protective shoes spread pressure and prevent damage. |
| 3. Keep feet clean and dry. | Moist skin between the toes encourages fungal infection, and dry cracked heels allow germs in. Clean, dry and moisturized skin keeps the barrier intact. |
| 4. Refer to podiatry. | A podiatrist can assess nerve and blood flow, treat calluses and advise on footwear, which lowers the chance of ulcers in a high-risk foot. |
| 5. Control sugar. | High blood sugar damages nerves and blood vessels and slows healing. Better control lowers the risk of further nerve damage and infection. |
Expected outcomes
- No ulcer or open skin develops.
- No infection.
- Daily foot checks.
- Proper shoes.
Linking the data to the diagnosis
This is a risk diagnosis because there is no ulcer yet. The patient has numb feet, says, "I cannot feel my feet," and has dry cracked heels, tight shoes, weak foot pulses and a blood sugar of 14 mmol/L. There is no open skin, so an actual foot ulcer diagnosis would be wrong; nerve damage and poor foot care are the risk factors. The plan protects the skin and improves control of sugar. The aim is no infection, daily foot checks and proper shoes.