Home' Australian Pharmacist : Australian Pharmacist July 2016 Contents Australian Pharmacist July 2016 I © Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
Patients and health professionals alike
can underestimate the link between a
presentation that may seem innocuous
and rapid progression to ulceration
Patients can also present to the
pharmacy with stages 4 through 6
(see Table 2). Any of these presentations
should result in a prompt referral to
the GP for assessment and treatment.
The GP will need to coordinate care and
refer the patient to other allied health
professionals for a complete treatment
regimen that must take into account far
more than the presenting wound.
How can Christina prevent
Preventing complications is two‐fold;
tight control of blood glucose levels
and diligence in monitoring the feet for
signs of injury. Patients need to develop
a habit of checking their feet every day,
changes in skin colour (infection or
dryness or maceration
changes in pain and touch sensitivity
noticeable temperature variance that
can be caused by lack of blood flow
(cold) or infection (hot)
changes in shape, including dropped
arches, curling or raised toes
calluses, corns and blisters, which may
be caused by wear and tear, poorly
fitting shoes, or poorly healed injuries
broken skin or other injuries.
Patients should be encouraged to
develop a routine that involves visual
and manual checking of all surfaces of
the foot and between the toes, to ensure
that there is no damage or infection. For
patients who are not flexible enough to
visually check their feet, assistance from
other family members or use of mirrors
should be encouraged.
Maintenance of the foot may also
require the assistance of a podiatrist,
depending on the level of existing
complications and the ability of the
patient to reach their feet. Cutting of
toenails needs to be done regularly
to prevent damage from long nails.
This should be done in a ’straight across’
fashion to prevent ingrowing nails
Patients should be encouraged to
see their GP or podiatrist about
all symptoms affecting their feet.
This means they should avoid using
over‐the‐counter preparations for
conditions such as corns or calluses
without the assistance of a podiatrist or
GP. These products can cause damage
to the foot without the patient realising
it, and since the normal healing process
can be compromised in a patient with
diabetes, these products may cause
more harm than good.
Should Christina see
In pharmacy, the primary role a
pharmacist can play is to educate
patients about the risks of diabetic
foot complications. As diabetic foot
complications can have a devastating
impact on morbidity and mortality,
a referral to a podiatrist and the
patient’s GP should accompany all
recommendations provided for the
When a patient presents with
complications, it is important that
the underlying condition is assessed.
In Christina’s case, she may have had
autonomic neuropathy for some time, or
this may be an emerging complication
that signals poor blood glucose control.
In either case, the presenting symptoms
will require input from her GP. She
will need to have an assessment of
her diabetes, and her GP will need to
assess her for other complications of
diabetes such as retinal damage, renal
insufficiency, and cardiovascular risk.
COUNSELLING IN PRACTICE
Some area health services and
local councils offer subsidised
Department of Veteran Affairs
(DVA) gold card holders are
entitled to free podiatry services
from private podiatrists.
Private health funds cover some
Medicare may provide a rebate on
podiatrists’ fees for people with
diabetes who are referred by their
A doctor can refer people with
diabetes to high‐risk foot clinics.
State Podiatry Associations can
identify podiatrists who specialise
Box 2. Accessing podiatry services4,10
When a patient presents with complications, it is
important that the underlying condition is assessed.
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