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Team Approach to Diabetic Foot Care

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I often get asked what I like best about my career as a Pedorthist. While there are many things I enjoy, particularly interacting with clients and problem solving, the most enjoyable part of my career is being a member of a healthcare team. As a foot expert I work in collaboration with podiatrists, wound care nurses, endocrinologists and family doctors, to improve the quality of patients’ lives. Within my own clinic, I also work as a team with my pedorthic colleagues and we regularly share learning experiences, insights, and consult with each other during patient assessments. This team approach is particularly important when caring for patients living with diabetes.

I recently cared for a patient who was referred to me from a podiatrist. This patient was suffering from Charcot Joint Disease – a diabetic condition that causes the middle part of the foot to fracture and collapse over time and then fuse.  The patient also had an open foot ulcer. As the Charcot was stable I began by fitting the patient with Darco healing sandals and modified them to offload the ulcer.   The healing sandals are designed to protect and take pressure off foot ulcers to help them heal.  After three months the ulcer had healed so I created custom foot orthotics and orthopedic shoes with a modification to reduce the chance of a recurrence. I also recommended diabetic friendly socks.  These socks are non-cotton to help wick moisture away from the feet and are seam free for further protection.  Although this patient’s feet are now healed, he has high risk feet, so I see him every six months for a follow up to check his feet and to check the wear on the orthotics.

A proactive health care team is particularly important for people who have high risk feet. Peripheral neuropathy (reduced sensation in the feet) is a common complication of diabetes.  In advanced stages it is a painless condition and often people aren’t aware they have it until problems have developed. As a precaution all Canadians living with diabetes should consider their feet at higher risk and they should have their feet checked regularly by a podiatrist, family doctor and a pedorthist.

I have been working as a pedorthist for the past nine years and I have treated many patients living with diabetes over the years with custom foot orthotics, footwear modifications and counseling about appropriate footwear and foot care. Each and every case is different but the goal is the same – to improve the quality of the patient’s life. Working in collaboration with other healthcare professionals I have successfully improved patient’s mobility, minimized complications and prevented possible amputations.

By Chris Hope, C. Ped Tech (C), C. Ped (C), Vancouver, BC

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