Did you know that complications from diabetes are responsible for 60% of non People with diabetes are commonly overweight, which nearly doubles the risk of …
September 2007
TABLE OF CONTENTS:
Welcome
The American Podiatric Medical Association states that Every 30 seconds, a
lower limb is lost to diabetes somewhere in the world In a tribute to our
feet, we will look at some of the common issues that are seen in mobile
populations and ways to help patients keep their feet healthy
Tools and Resources
:: Common Foot Problems and their treatments
Success Stories
:: Sox for Socks - a look at Boston Health Care for the Homeless Programs
innovative campaign to collect socks for their patients
Simple Solutions Highlighting PDSA cycles or creative approaches to
problems
:: Basic foot care
:: How to find a podiatrist in your area
Feedback from the Field
:: Guide to Integrating Community Health Workers into Health Disparities
Collaboratives
WELCOME
Health Care for the Homeless HCH Clinicians Network and Migrant
Clinicians Network MCN are pleased to welcome you to the Fall edition of
our joint e-newsletter, Reaching the Underserved: Connecting Mobile
Homeless People to the Health Disparities Collaboratives HCH Clinicians
Network and MCN serve as National Partners to the HRSA Health Disparities
Collaboratives In this newsletter, we
take a look at our feet and pay
tribute to ways we can keep them healthy as they carry us throughout our
days
:: :: :: :: :: :: :: :: :: :: :: ::
Did you know that complications from diabetes are responsible for 60 of
non traumatic lower limb amputations? And, that according to the American
Podiatric Medical Association, comprehensive foot care programs can reduce
amputation rates by 45 to 85? Well, here are some tools to help you to
better care for your feet
:: TOOLS AND RESOURCES
|Foot Problem |Treatment |
|Calluses |Padding, manual and mechanical |
| |trimming, shoe gear modification |
|Corns |Manual and mechanical trimming, |
| |padding, surgical correction |
|Dry Skin Xerosis |Moisturizer/cream/ointment, |
| |keratolytic, emollient, increase water|
| |intake, humidifier use |
|Bunions |Shoe gear
modification, padding, |
| |orthoses, surgical correction |
|Hammertoes |Flexible crest pads, trimming |
| |corns/calluses, shoe gear |
| |modification, surgical correction |
|Ingrown Nails |Slant back procedure, partial/total |
| |nail avulsion, chemical matrixectomy, |
| |excisional matrixectomy |
|Fungal Nails |Topical antifungals, oral antifungals,|
| |combination therapy, manual and |
| |mechanical trimming |
|Plantar Verucca |Acids, cryotherapy, excisional, laser |
|Tinea Pedis |Topical antifungals, oral antifungals,|
| |combination therapy, domboro soaks, |
| |antibiotics |
|Ulcers |Off
loading the foot, dressing |
| |changes, antibiotics, debridement, |
| |surgical debridement, referral to |
| |vascular surgery |
|Neuropathy |Topical agents lidoderm, oral |
| |medications, blood sugar control |
| |
|Others include: gout, plantar fasciitis, mortons neuroma, sprains, exposure|
|issues frostbiteand gangrene |
|Hansens Disease: There are special foot issues that are specific to persons|
|with Hansens Disease To learn more about Hansens disease and its |
|treatment go to HRSAs website at http://wwwhrsagov/hansens/ |
:: :: :: :: :: :: :: :: :: :: :: ::
SUCCESS STORIES
:: In 2005, Bostons Health Care for the Homeless Program initiated a small
community campaign to collect new white socks for their patients Socks
are an integral component to the health care provided to patients Many
homeless people
are on their feet a great deal of the time and this, along
with the cold, wet weather, render a persons feet especially vulnerable to
infection and injury Unable to purchase new socks or launder existing
socks can leave many who are homeless wearing the same pair day in and day
out BHCHP has several clinics that are specifically dedicated to foot
care Patients are invited to soak their feet and trim their nails, while
providers offer foot exams and treat common ailments such as tinea pedis
Being able to provide a new pair of clean socks to a patient is a small
action that can carry a big result
Two years ago the campaign was greatly enhanced when the Boston Red Sox
along with the New England Sports Network NESN teamed up to help They
generously spread the word of this campaign to their supporters and
designed a program entitled Sox for Socks where fans were invited to bring
new white socks to specific home games With their generous support the
campaign expanded from its initial collection of 10,000 socks to a soaring
total of over 40,000 socks collected with their help By donating socks,
its a simple, concrete way people can make a difference The Red Sox
Foundation has
played a major role in creating a safety net of socks for
BHCHPs patients
:: :: :: :: :: :: :: :: :: :: :: ::
SIMPLE SOLUTIONS
Wash feet daily
Using mild soap and lukewarm water, wash your feet in the mornings or
before bed each evening Dry carefully with a soft towel, especially
between the toes, and dust your feet with talcum powder to wick away
moisture If the skin is dry, use a good moisturizing cream daily, but
avoid getting it between the toes
Inspect feet and toes daily
Check your feet every day for cuts, bruises, sores or changes to the
toenails, such as thickening or discoloration If age or other factors
hamper self-inspection, ask someone to help you, or use a mirror
Try to lose weight
People with diabetes are commonly overweight, which nearly doubles the risk
of complications
Wear thick, soft socks
Socks made of an acrylic blend are well suited, but avoid mended socks or
those with seams, which could rub to cause blisters or other skin injuries
Try to Stop smoking
Tobacco can contribute to circulatory problems, which can be especially
troublesome in patients with diabetes
Cut toenails straight across
Never cut into the corners, or taper, which could
trigger an ingrown
toenail Use an emery board to gently file away sharp corners or snags If
your nails are hard to trim, ask your podiatrist for assistance
Exercise
As a means to keep weight down and improve circulation, walking is one of
the best all-around exercises for the diabetic patient Walking is also an
excellent conditioner for your feet Be sure to wear appropriate athletic
shoes when exercising Ask your podiatric physician whats best for you
See your podiatric physician
Regular checkups by your podiatric physician-at least annually-are the best
way to ensure that your feet remain healthy
Be properly measured and fitted every time you buy new shoes
Shoes are of supreme importance to diabetes sufferers because poorly fitted
shoes are involved in as many as half of the problems that lead to
amputations Because foot size and shape may change over time, everyone
should have their feet measured by an experienced shoe fitter whenever they
buy a new pair of shoes
New shoes should be comfortable at the time theyre purchased and should
not require a break-in period, though its a good idea to wear them for
short periods of time at first Shoes should have leather or canvas
uppers,
fit both the length and width of the foot, leave room for toes to wiggle
freely, and be cushioned and sturdy
Dont go barefoot
Not even in your own home Barefoot walking outside is particularly
dangerous because of the possibility of cuts, falls, and infection When at
home, wear slippers Never go barefoot
Dont wear high heels, sandals, and shoes with pointed toes
These types of footwear can put undue pressure on parts of the foot and
contribute to bone and joint disorders, as well as diabetic ulcers In
addition, open-toed shoes and sandals with straps between the first two
toes should also be avoided
Dont drink in excess
Alcohol can contribute to neuropathy nerve damage which is one of the
consequences of diabetes Drinking can speed up the damage associated with
the disease, deaden more nerves, and increase the possibility of
overlooking a seemingly minor cut or injury
Dont wear anything that is too tight around the legs
Panty hose, panty girdles, thigh-highs, or knee-highs can constrict
circulation to your legs and feet, as can mens dress socks if the elastic
is too tight
Never try to remove calluses, corns, or warts by yourself
Commercial, over-the-counter
preparations that remove warts or corns should
be avoided because they can burn the skin and cause irreplaceable damage to
the foot of a diabetic sufferer Never try to cut calluses with a razor
blade or any other instrument because the risk of cutting yourself is too
high, and such wounds can often lead to more serious ulcers and
lacerations See your podiatric physician for assistance in these cases
To find a podiatrist in your area, go to http://wwwapmaorg
Then click on: Find a Podiatrist
:: :: :: :: :: :: :: :: :: :: :: ::
FEEDBACK FROM THE FIELD
Guide to Integrating Community Health Workers into Health Disparities
Collaboratives
Community Health Workers CHWs are trained to promote health in their own
communities by providing leadership, peer education and resources to
support community empowerment They integrate information about health and
the health care system into the communitys culture, language and value
system, thus reducing many of the barriers to health services CHWs are
especially effective with management of chronic diseases, prevention and
health education, making them ideal partners for Health Disparities
Collaboratives
To help maximize the benefits
of CHW programs, Migrant Clinicians Network
and Migrant Health Promotion have developed a new resource, which provides
concrete tips for incorporating CHWs into Health Disparities
Collaboratives The Guide to Integrating Community Health Workers into
Health Disparities Collaboratives is laid out in two sections The first
section is tailored to each Collaborative Topic diabetes, cancer, etc
with suggestions for how CHWs can promote significant outcomes within a
variety of measures The second section describes roles for CHWs in five of
six components of the Chronic Care Model Examples in The Guide focus
specifically on farmworkers; however, many of the concepts and ideas are
transferable to other populations
The Guide to Integrating Community Health Workers into Health Disparities
Collaboratives can be downloaded from the library at
wwwhealthdisparitiesnet or from wwwmigranthealthorg/publications
For more information, contact:
Anica Madeo, Regional Capacity-Building Director
Migrant Health Promotion
amadeo@migranthealthorg
734-944-0244
:: :: :: :: :: :: :: :: :: :: :: ::
Editors:
Jennie A McLaurin, MD, MPH
Health Disparities Collaboratives Coordinator
Migrant
Clinicians Network
jmclaurin@migrantclinicianorg
Sharon Morrison, RN, MAT
Health Disparities Collaboratives Coordinator
HCH Clinicians Network
National Health Care for the Homeless Council
smorrison@nhchcorg
This project was developed with the support of the Health Resources and
Services Administration HRSA The views expressed in this document do
not necessarily reflect the views of HRSA
