Peripheral Vascular Disease: Selecting The Right Shoes-Diabetes

Advise your patient to purchase shoes that are made of natural material, such as leather. Explain that synthetics don't allow enough air circulation. If she has decreased sensation in her feet, suggest that she take a family member along when she buys new shoes. She can ask the family member to feel her foot through the shoe to make sure it isn't too tight. If necessary, tell her how to order adaptive footwear, such as extradepth or specially constructed shoes.

If your patient has an orthotic insert and she's buying regular shoes, tell her to make sure she has enough room between the sole and upper part of the shoe for the insert. Explain that orthotics help avoid pressure sores by dispersing pressure evenly across her foot. If she has foot deformities, such as claw toes, tell her to make sure that her toes don't rub against her shoe.

Tell your patient that good running shoes made of soft fabric may be an acceptable alternative to custommade shoes. Advise her to select running shoes that have a wide toe area and a thick sole and that lace up the front, not the side. Explain that by wearing comfortable running shoes, she'll have better balance and walk more comfortably.

Encourage her to avoid high heels because they increase pressure on the ball of the foot and may decrease sensation. Instead, she should buy low heels or flats.

Wearing New Shoes

Advise your patient to wear new shoes for about 2 hours and then examine her feet for pressure areasred spots that may turn into blisters. If she finds no pressure areas, she can continue to wear the shoes for a few more hours and then examine her feet again. If she still finds no pressure areas, she should increase the wearing time slowly over a few days. If she does notice pressure areas, she should avoid wearing the shoes because a foot ulcer may develop.

Chronic Complications od Diabetes

A patient with diabetes mellitus has a high risk of developing chronic complications that can affect just about every body system. If untreated or improperly managed, many of these complications can lead to painful, debilitating, or life-threatening conditions.

Along with other members of the health care team, you're responsible for helping your patient understand that she's at risk for developing microvascular, macrovascular, and neuropathic complications and for teaching her how to prevent them or to slow their progress. If your patient is hospitalized because of chronic complications, you'll need to provide her with thorough teaching about self-care after discharge. To help ensure that she follows through, include family members in your teaching. If your patient will have a home care nurse, she'll evaluate the plan of care continually to determine whether or not the patient is meeting her goals.

Your teaching and plan of care should focus on helping your patient better control her diabetes to postpone or help prevent the onset of complications, detecting signs and symptoms that indicate the onset of complications and intervening appropriately.

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