diabetic foot and leg care, the special attention given to prevent the circulatory disorders and infections that frequently occur in the lower extremities of diabetic patients. ▪ METHOD: The patient should be taught to examine the legs and feet daily for signs of dry, scaly, red, itching, or cracked skin; blisters; corns; calluses; abrasions; infection; blueness and swelling around varicosities; and thickened, discolored nails. The feet should be bathed daily in tepid water with mild or superfatted soap and dried gently but thoroughly with a soft towel. A lanolin-based lotion is then applied, although not between the toes; excess lotion is removed with a dry towel; vigorous rubbing and use of alcohol preparations are avoided because of drying and irritation of skin, which can lead to skin breakdown. Calluses and corns are removed, and thickened, deformed nails are cut by a podiatrist. Commercial remedies for removing calluses and corns should not be used. ▪ INTERVENTIONS: The nurse provides foot and leg care while the diabetic patient is hospitalized. Before discharge the patient is instructed to examine and bathe the feet daily according to the recommended method, to report abnormalities, to keep the feet dry at all times, to wear cotton socks or stockings with cotton feet, and to place clean lamb’s wool or cotton between the toes if they perspire. The patient is cautioned to avoid sustaining foot or leg trauma, walking barefoot, scratching insect bites, using a hot-water bottle or heating pad on the lower extremities, getting a sunburn, wearing constricting garments, remaining in the same position for long periods, sitting at more than a right-angle bend, and crossing the knees. The individual with diabetes is advised to alternate the wearing of two pairs of rubber-soled, well-fitted shoes wide enough to prevent pressure and rubbing; to air each pair of shoes between use; and to break in new shoes gradually. The patient often benefits from therapy to walk to tolerance daily, to plan exercise periods after meals, to bend and straighten the knees and rotate the ankles occasionally when sitting, and, when standing, to shift weight from time to time and walk in place. Patients may be referred to a certified diabetic educator for initial instruction about care. ▪ OUTCOME CRITERIA: Meticulous care of the feet and legs can prevent serious complications, including local infection, skin ulcers, cellulitis, and gangrene.
