What discharge instructions should be given to a diabetic patient with a traumatic toe injury?

Discharge Instructions for Diabetic Patients with Traumatic Toe Injuries

Prior to discharge, a diabetic patient with a traumatic toe injury must be clinically stable, have had any urgently needed surgery performed, achieved acceptable glycemic control, be able to manage at their discharge location, and have a well-defined care plan including appropriate antibiotic regimen (if needed), off-loading scheme, specific wound care instructions, and scheduled follow-up appointments. 1

Wound Care Instructions

Daily Foot Inspection

• Perform daily inspection of the injured toe and entire foot, including areas between toes
• If unable to perform self-inspection due to visual impairment, arrange for a family member or caregiver to assist
• Check for:
  • Changes in color or temperature
  • New blisters, cuts, scratches, or ulcers
  • Increased swelling, redness, or drainage
  • Foul odor from the wound

Wound Management

• Clean the wound daily with mild soap and water (temperature always below 37°C)
• Dry carefully, especially between toes
• Apply prescribed dressing according to specific instructions:
  • For heavily exuding wounds: foam or alginate dressings may be recommended
  • For wounds with necrotic tissue: hydrogels may be beneficial
  • Avoid occlusive dressings for infected wounds 2
• Change dressings at the frequency recommended by your provider (typically daily or more often for heavily exuding wounds)
• Do not use chemical agents or plasters to remove corns and calluses 1

Infection Prevention and Monitoring

Signs of Infection to Watch For

• Notify healthcare provider immediately if you notice:
  • Increased pain, redness, swelling, or warmth around the wound
  • Foul-smelling or colored drainage
  • Fever or chills
  • Markedly increased foot temperature
  • Worsening of the wound despite following care instructions

Antibiotic Use

• If antibiotics were prescribed:
  • Take the full course exactly as prescribed
  • Do not stop early even if symptoms improve
  • Report any adverse effects to your healthcare provider
• If no antibiotics were prescribed, this is appropriate for uninfected wounds 1

Off-loading and Footwear

Pressure Relief

• Follow specific off-loading instructions provided (may include special footwear, boot, or cast)
• Avoid bearing weight on the affected foot/toe as instructed
• Use assistive devices (crutches, walker, wheelchair) if recommended

Footwear Guidelines

• Do not walk barefoot, in socks without footwear, or in thin-soled slippers, whether at home or outside
• Wear prescribed therapeutic footwear at all times if recommended
• Inspect inside all shoes before putting them on to ensure no foreign objects are present
• Do not wear shoes that are too tight, have rough edges or uneven seams
• Wear socks without seams (or with seams inside out) and change them daily 1

Glycemic Control

• Monitor blood glucose levels as instructed
• Take diabetes medications as prescribed
• Record blood glucose readings and bring them to follow-up appointments
• Contact your diabetes care provider if blood glucose levels are consistently outside target range

Activity and Lifestyle

• Avoid activities that could cause further trauma to the foot
• Do not use any kind of heater or hot-water bottle to warm feet
• Use emollients to lubricate dry skin, but not between toes
• Cut toenails straight across to avoid ingrown toenails 1

Follow-up Care

• Attend all scheduled follow-up appointments
• Return for evaluation sooner if:
  • The wound shows no improvement after 4 weeks of standard therapy
  • The wound worsens at any time
  • You develop fever or other signs of systemic infection
  • You have increased pain or new symptoms

When to Seek Immediate Medical Attention

• Fever above 101°F (38.3°C)
• Increased pain not relieved by prescribed pain medication
• Redness or swelling extending beyond the wound area
• Foul odor from the wound
• Drainage that increases or changes in color
• Inability to bear weight on the foot when this was previously possible

Pitfalls to Avoid

• Do not ignore even minor changes in the wound appearance or symptoms
• Do not delay seeking medical attention if the wound worsens
• Avoid self-treatment with over-the-counter medications or home remedies
• Do not soak the foot in hot water or use heating pads
• Avoid wearing constrictive footwear that could further damage the toe

By following these discharge instructions carefully, you can significantly reduce the risk of complications and promote optimal healing of your traumatic toe injury.