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Field Manual for Foot Health
The Battle to Fight Diabetic Foot Problems

Click here for PDF version of the field manual. 

Photo of foot with ulcer
Foot problems like the one pictured above are a common problem facing American veterans. With the right training more serious conditions can be avoided.

Department of Veterans Affairs, National Headquarters
Jeffrey M. Robbins, DPM, Director, Veterans Health Administration, Headquarters Podiatry Services

The Enemy

American Veterans have always met the challenges of foreign enemies.  Today many Veterans face another type of enemy, diabetes. This enemy is tireless and relentless. Worse yet, it is an enemy from within. 

The diagnosis of diabetes is the beginning of a battle that must be waged with stubborn determination if it is to be won. 

The Briefing

If you are a Veteran that has diabetes, your body is not able to use sugars and carbohydrates that you eat. Diabetes causes complications including:

  • Eye disease

  • Heart disease

  • Increased chances of infection and foot problems

  • Kidney disease

Diabetes can cause foot problems, including:

  • Increased chances of infection

  • Loss of feeling or sensation

  • Poor circulation

This brochure will provide you with some weapons to fight diabetic foot problems and decrease your chance of amputation. 

Preparing for War

Good preparation requires the following:

  • Good intelligence reports

  • Advanced planning

  • Quality training

  • Determined implementation

Intelligence Report

Here is what we know about diabetes and how to prevent its complications.

  • Diabetes is 1 of 10 leading causes of death in the United States.

  • Each year more than 67,000 lower limbs are amputated as a result of diabetes complications.

  • Patients with diabetes are two to four times more likely to develop heart disease and stroke than people who do not have diabetes.

  • Diabetes is the leading cause of blindness in adults younger than age 75.

  • Diabetes is the leading cause of kidney failure.

  • People with diabetes who smoke are at special risk because smoking causes problems in blood flow through veins and arteries.

  • Poor blood flow to the lower leg can delay healing.

  • Impaired white blood cell function can decrease the ability to fight infection.

  • Nerve damage can leave the foot unable to feel sharp objects.

Proper diet, exercise, medical care, and prevention at home can keep the most serious of these complications at bay.

Planning

How can you keep diabetic foot complications at bay?

It is easier to prevent a foot wound than it is to treat one. For that reason, it is important to prevent these complications before they start. To be effective, prevention is a lifetime effort. You must be vigilant. You cannot let your guard down in this fight.

Training

What do you need to do to wage this war? What are your options and what can you control?

Basic Training

  • If you are overweight, eat a proper diet to lose and maintain your weight.

  • Exercise on a regular basis (at least 3 times weekly for 30 minutes each time).

  • Regularly self-monitor your blood sugar.

  • Get regular medical care to help you control blood sugar.

  • Do not use tobacco.

Physical Preparedness

  • Wash your feet daily.

 Photo of person washing feet

John Smerillo, former Petty Officer Third Class, USN, has had diabetes for 10 years.

  • Dry well between each toe.

Photo of person drying between toes

Tommie Styles, former Corporal, US Army, has had diabetes for 20 years.

  • Pat dry, do not rub.

Photo of person drying foot

Marian Elder, former Captain, USAF Reserves, has had diabetes for 22 years.

  • If your skin is dry, use lotion to moisturize but never use it between the toes.

Photo of person applying lotion to feet

Raymond Hammond, former Private First Class, US Army, has had diabetes for 10 years.

  • If your skin is wet from sweating, use an antifungal foot powder daily. 

Photo of person applying antifungal powder to foot

Howard Smith, former Corporal, US Marine Corps, has had diabetes for 17 years.

  • Do not soak your feet in hot water

Photo of person soaking feet

Charles Evans, former Private First Class, US Army Amphibious Corps, has had diabetes for 30 years.

Equipment Maintenance

  • Wear a clean pair of socks daily.

Photo of feet with socks

Cornell Williams, former Seaman, US Navy, has had diabetes for 10 years.

  • Make sure your shoes fit well. Your shoe size may change so get measured for a proper fit each time you buy shoes.

Photo of feet with shoes

Evan Ransom, former Private First Class, US Army, has had diabetes for 3 years.

  • Powder your shoes daily with a small amount of an antifungal foot powder, since your shoes can’t be washed regularly.

  • Wear shoes and socks designed for the weather. It is very important to protect your feet from the cold. And don’t forget to apply sunscreen to the tops of your feet in the hot sun.

  • Wear good-fitting shoes rather than slippers in your home and when walking or standing for long periods of time.

Photo of bare feet

George Rody, former T-5, Army Corps of Engineers, has had diabetes for less than one year.

  • Inspect your feet daily. Use a mirror on the floor if it is difficult for you to see the bottom of your foot.

Photo of a person inspecting feet using a mirror on the floor

Clifford Holt, former Petty Officer, US Navy Reserve, has had diabetes for 30 years.

  • Look for any breaks in the skin or areas of irritation such as blisters or red areas.

Photo of foot with sores

  • Look for any nail problems.

Photo of irritated toenail

  • Look for corns and calluses.

Photo of foot with calluses

Technical Procedures (PMCS: Preventative Maintenance Care and Service)

  • Cut your nails straight across and file the edges smooth.

Photo of person filing toenail

Calvin Glasscock, former Private First Class, US Army, has had diabetes for 3 years.

  • Do not cut into the nail margin.

  • If your nails are curved in, thickened or hard to cut, see your podiatrist or foot care specialist.

Photo of curved, thickened toenails

Kathleen Selvey, former E-3 Sergeant, US Army, has had diabetes for 3 years.

  • If you have vision problems and can’t see your feet well or if it is hard for you to reach your feet, visit your podiatrist or foot care specialist.

  • Your foot care provider should manage your corns and calluses. Don’t try to remove them yourself.

  • Minor cuts, scratches, and blisters can all threaten your limbs. Get treatment from your podiatrist or foot care specialist as soon as possible.

  • The Veterans Health Administration recommends annual foot checkups.

  • You may be referred to a podiatrist or foot care specialist to manage any of the problems listed in this manual.

Implementation

This is not going to be an easy battle, but it is a battle that we can win. We can hold off this enemy indefinitely until science finds a strategic advantage. It is our job together to resist the forces against us. You are not alone in this campaign. There is help and assistance as close as your telephone. Please don’t hesitate to call your podiatry service or foot care specialist for assistance.

Image of logo representing podiatry

Author: StayWell Custom Communications
Last Annual Review Date: 8/16/2016
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