Renal Foot


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Although there is no general agreement on the definition of renal foot, the ‘renal foot’ is a term often used to refer to patients with stage 4/5 kidney disease. There are 5 divisions of renal failure. Patients requiring dialysis are classed at level 4 or 5. Increased awareness of this condition and careful clinical examination are critical to avoid serious complications. The potential consequence of poor management of the renal foot are considerable: prolonged ulceration and ill health, gangrene and amputation, depression and death.


  Assessment

The risk status of any patient on dialysis should automatically be considered as being high, in the absence of any active foot problems. A referral to a podiatrist for expert advice and treatment if an active foot problem is discovered.

  •    For every patient in dialysis, a foot check should be carried out before and after treatment.
  •    Patients need to keep an eye on their feet at home and during their time on dialysis.  It is essential to ensure that patients receive a quality foot check from a podiatrist at every appointment and reiteration of foot care advice.

Causes

The causal pathways of the foot in renal failure are multiple and inter-related. Three major pathologies--neuropathy, ischemia and infection--are the main contributory factors. Increased awareness of this condition and careful clinical examination avoid serious complications.  

    Patient Information and Inspection

     All patients should be encouraged to carry out a daily inspection to look\ for:

    • Damage to the nerves that might be indicated by: 
    • tingling sensation; "pins and needles"
    • pain (burning)
    • feet that are red and hot to touch
    • sweating less
    • changes to the shape of the feet
    • hard skin
    • loss of feeling in the feet/legs.
      • Damage to the blood supply which might be indicated by:
      • cramp in the calves (at rest or when walking)
      • shiny smooth skin - loss of hair on the legs and feet
      • cold, pale feet - changes in foot skin colour.
      •  pain in the foot/feet
      • swollen feet.
      • wounds or sores that do not heal



      Symptoms

      Symptoms of the the ‘Renal Foot’ are:

      • Hypoxia
      • Cachexia
      • Immune paresis
      • Anaemia
      • Charcot
      • Ischaemia
      • Deformity
      • Swelling/Oedema
      • Lesions/Infection/Ulcers/Cracks or breaks in the skin
      • Discrete areas of necrosis
      • Discolouration
      • Motor power

        Treatment

      Appropriate management needs to address all contributory factors. Treatment options include revascularization, off-loading to relieve high-pressure areas and aggressive control of infection. Equally important is the collaboration between health care providers in a multidisciplinary  team approach. Moreover, patient education on the measures required to achieve both primary and secondary prevention is of great value. Treatment of the renal foot can really only be done with the treatment of the patients' chronic kidney disease. 


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      Phone:  905-475-3098

      Email: contact@opma.ca 

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