As a medical professional treating patients with peripheral neuropathy, you want to have a positive effect on your patients.

More than half the patients admitted that they walked around the house and even outside with no shoes.

You treat them…
You worry about them…
You advise them…
But are they really listening to what you tell them?
If your patients have peripheral neuropathy in their feet, chances are really good they’re not listening to you.  They hear you but they’re not taking what you tell them home.
A recent study that followed 41 patients with type 2 diabetes and peripheral neuropathy found that

  • 90% of the patients had been educated about proper footwear
  • 83% washed and dried their feet properly every day
  • 51% actually perform foot self-exams recommended by their doctors

But more than half the patients admitted that they walked around the house and even outside with no shoes.  And more than two thirds of them were not wearing appropriate footwear.  They were wearing shoes with pointed toes, high heels or flip flops, and even worse.
If you want to really get through to your peripheral neuropathy patients, you need to impress on them how serious they’re condition is and exactly what can happen to them if they don’t follow your instructions.
Step One  – The Thorough Foot Examination[1]
If you have patients with peripheral neuropathy in their feet, even if they don’t present with foot issues, you need to be proactive as their physician and ensure that you see them at least once a year for a complete foot examination. 
When you’re examining their feet, make sure you: 

  • Examine each foot between the toes and from toe to heel.  Make extensive notes in the chart of any problems by drawing or labeling the finding on the foot diagram.  If your patient has skin that is thin, fragile, shiny and hairless, they could have problems with their circulation and that means possible nerve damage. 
  • Ask the patient if they’ve noticed any change in how their feet sweat.  If their feet don’t sweat as they normally would they can develop dry, cracked skin and those cracks can become infected.
  • If your patient is wearing nail polish, take it off.  Check for ingrown toenails, deformed nails or any type of nail fungus. 
  • Make notes on the diagram and in the chart of any areas on the feet that are noticeably dry, red or warm to the touch.

Step Two  – Patient Education
In order to prevent serious problems, your peripheral neuropathy patients need to know how to care for their feet and what to watch for so they can come in to see you before they reach a point  of no return. 
Here’s a good checklist to provide to your patients to remind them of exactly what they need to do to help themselves[2]:

  • Check their feet every day.  Look at their bare feet to make sure they don’t have any sores, blisters, or swelling.  If they can’t see the bottoms of their feet, they should use a mirror or ask someone else to check them.
  • Wash their feet every day and dry them completely to eliminate the possibility of fungus growth.  Make sure they pat their feet dry – don’t rub them.   
  • Use a good lotion on their feet to keep skin smooth and prevent dry, cracked skin.  Don’t use lotion between the toes – it will keep the skin there too moist and that breeds bacteria.
  • Trim their toenails but not too short.  Cut them straight across and file the edges with a nail file to prevent ingrown toenails and cut them right after they bathe while the nail is still soft.
  • Always wear shoes and socks – even inside the house.  If they have neuropathy, it’s just too easy to step on something and injure their feet without even feeling it.
  • Wear comfortable shoes, preferable shoes designed for people with peripheral neuropathy in their feet.  Check their shoes before they put them on and make sure the lining is intact and smooth and that nothing is in their shoes.  Talk to them about Medicare assistance with purchasing special shoes. 
  • Never put their feet in hot water.  Always check the temperature of their bath water with the elbow before stepping into it. 
  • Never use hot water bottles or heating pads on their feet.  Neuropathy makes it harder to sense extreme temperatures and they can burn their feet without even knowing it.
  • When sitting down, they should prop their feet up to keep the blood circulating.  Move the toes and ankles to keep the blood pumping.
  • Never cross their legs when sitting.

Don’t just tell them what they need to do and take it for granted that they understand what you’re telling them.  Ask them to demonstrate the steps to proper foot care so you know they know what you’re saying and that they are physically capable of doing what you’re telling them to do.  Offer clinics on proper foot care for your patients with peripheral neuropathy in their feet. 
And offer your peripheral neuropathy patients an ongoing monitoring and follow up program.  Keep in touch and watch for any of the symptoms of peripheral neuropathy in the feet. 
Peripheral neuropathy in the feet impairs the ability to feel pain and they may not notice the problem until it’s too late for successful treatment.  It never hurts to have a fresh pair of eyes (yours) keeping watch over them.
When you’re trained and ready to treat them, let us help you reach them.
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