Guest blog from Meredith Bassler, RN
Imagine coming home at the end of the day, taking off your shoes, and finding that you had been walking with a pebble in your shoe all day long. As the pebble went unnoticed, it was allowed to wear away at the delicate skin on the bottom of your foot, creating a wound. Patients with advanced type 2-diabetes mellitus often lose feeling in their toes and feet, a condition called peripheral neuropathy. This combined with other aspects of the disease leaves these patients more susceptible to non-healing ulcers on their feet. If a patient with type 2-diabetes gets a small cut on his foot, he could not feel or notice it until the wound is already advanced and needs medical treatment. The CDC estimates that there are 1.7 million new cases of type-2 diabetes diagnosed every year; and, staggeringly, there are around 73,000 amputations due to diabetes each year in the US (CDC, 2014). As a family nurse practitioner student in an outpatient podiatry clinic in San Francisco, I saw many patients who each told me the same story – “Well, I noticed a small cut on the bottom of my foot and put a band-aid on it, but it just got worse.” These patients are well-intentioned, but the problem with band-aids on the bottom of the foot is that they do nothing to relieve the pressure on the wound. The wound must be padded and relieved of any pressure in order to heal.
Urban clinics in a city like San Francisco can be rough. Supplies were often hard to come by, and if anything was left unattended, it would surely go missing. For example, we had one Doppler (a tool used to check for non-palpable pulses in the extremities) that was kept under lock and key even though we needed it every 10 minutes. We never had any scissors, and the ones we had never cut like they were supposed to. This forced healthcare providers to improvise any way they could to deliver the care the patients deserved. For patients with moderate wounds on their feet, we cut pieces of self-adhesive foam with a scalpel in the shape of the patient’s wound (a very tedious and dangerous job), and placed that foam in the bottom of the patient’s shoe. This method works well, but only hospitals have access to these rolls of foam, not patients. Even if they asked, we were not allowed to give the foam away for home use. This only “fixes” one pair of shoes. We could only put padding in the pair of shoes the patient brings to his appointment, so if he wanted to wear another pair of shoes, he could further damage his foot. Another issue is that this seemed to only address the larger wounds. I couldn’t help but think that if we could pad the smaller wounds, they would not turn in to large wounds.
Around 50% of our patients sought care due to wounds that had grown too large for home management. For them to take care of themselves, we needed padding readily available for all diabetics and easy to use; something patients could pick up at the drugstore. It also needed to be user friendly; I couldn’t have my diabetic patients carving away at foam with a scalpel! One day after clinic, I went to the drugstore and just stared at the foot-care section. I saw Dr. Scholl’s corn pads, circular foam pads with adhesive on the back. I grabbed as many as they had and went home, suddenly inspired. I began to cut the foam into pieces with the scissors from my desk, allowing me to make a variety of shapes. Having this variety of shapes is important, as each wound is shaped differently and irregularly, and the padding must be applied to the borders of the wound, no matter where on the foot the wound is located.
About a week later, a friend mentioned that he had a small wound on the bottom of his foot and wanted me to take a look at it. I cut the pads to the shape of his wound and told him to report how it felt, and if it helped or not. He said the padding did relieve the pressure and the wound didn’t get any bigger. So far, so good; but before showing my patients how to use the pads, I needed to talk to the podiatric surgeons and nurse practitioner that worked with me at the clinic. When I showed them my design, they were very supportive and agreed that it seemed like a good option for diabetic patients with small foot wounds.
Making with Patients
I brought in a few packages of pads I had bought at the pharmacy, by this point, I had discovered cheaper generic brands — $4.99 for 12 large pads and $3.99 for 18 small pads — available in oval-shaped as well as round shapes. I brought my scissors from home, to ensure I would have what I needed throughout the day, and we were ready to make. I started showing my diabetic patients how to recreate what I had done with the circular corn pads, and having them repeat the process to check if there were any further teaching needs. My patients loved the idea of being able to buy something at their closest pharmacy and turn it into something they could use at home. I encouraged my patients to use the pads early and often to prevent their small cuts from getting worse. I checked in on them and they reported back: the material was easy to obtain, easy to manipulate and it seemed to prevent tiny scrapes and scratches from becoming worse. I was thrilled; I had found something to make my patients’ lives easier and healthier! And as I saw my patients every 1-4 weeks for check-ups, I could see that the use of pads was being done correctly and safely. There was a difference in the quality of my patients’ feet – by employing my pharmacy hack, my patients’ wounds had been cared for and had not grown large enough to warrant any further intervention. For the price of a padded piece of foam, around .30 cents, my patients wereable to save themselves from the high cost associated with treatment of non-healing ulcers and the fear of amputation. There are 29 million Americans with diabetes according to the CDC. Each lower-limb amputation costs the Medicare system around $52,000 a year (Margolis, et al., 2011). If we taught them how to prevent small wounds from becoming amputations by making everyday padding, we could contribute to making treatment more affordable and accessible.
Meredith Bassler is a 2007 graduate of the Clemson University School of Nursing and is currently working towards her master’s degree in nursing at San Francisco State University where she will earn her family nurse practitioner certification. She lives in San Francisco and enjoys all types of exploration and creation! You can check out her Etsy jewelry store at: https://www.etsy.com/shop/CCWiseDesigns. Happy Making!
CDC.(2014). National diabetes statistics report. Accessed from:http://www.cdc.gov/diabetes/pubs/estimates14.htm
David J Margolis, MD, PhD, D Scot Malay, DPM, MSCE, Ole J Hoffstad, MA, Charles E Leonard, PharmD,
Thomas MaCurdy, PhD, Yang Tan, BA, Teresa Molina, BA, Karla López de Nava, PhD, and Karen L Siegel, PT, MA. (2011).
Economic burden of diabetic foot ulcers and amputations. Data Point Publication Series (3). Accessed from: http://www.ncbi.nlm.nih.gov/books/NBK65152/
Rice, et al. (2013). Burden of diabetic foot ulcers for Medicaire and private insurers.Diabetes Care 37(3). Accessed from: http://care.diabetesjournals.org/content/early/2013/10/29/dc13-2176.abstract