Comprehensive Diabetic Foot Examination

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Presentation of information for a comprehensive diabetic foot examination that is used in conjunction with the exam. Healthcare guide to diabetes and your feet can be obtained at www.drpelto.com

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Comprehensive Diabetic Foot Examination

  1. 1. Comprehensive Diabetic Footcare Examination
  2. 2. What is it?• An examination to evaluate and determine risk factors for patient’s with diabetes performed on regular basis based on symptoms. – Diabetes with no risk factors – Yearly – Diabetes with 1 risk factor – 2x a year – Diabetes with 2 risk factors – 3x a year
  3. 3. What are the risk factors?• Diabetes with the following – Foot deformity (Bunion, Hammertoe, Equinus) – Skin problems (Ulceration, Athlete’s Foot, Calluses, Fungal Nails) – Poor feeling (Neuropathy) – Poor circulation (Peripheral vascular disease) – Improper shoe gear
  4. 4. Initial Information• Last footcare visit • Doctor treating your• Last CDFE diabetes (PCP or• Changes medical Endocrinologist) history • Last date seen• Changes to medications• New foot concerns
  5. 5. Fasting Blood Sugar• Fast overnight or don’t eat anything for 8 hours• Draw blood to determine amount of blood sugar
  6. 6. Blood Sugar Numbers• Taken at various times during the day with glucometer
  7. 7. Hemoglobin A1C
  8. 8. What are the risk factors?• Diabetes with the following – Foot deformity (Bunion, Hammertoe, Equinus) – Skin problems (Ulceration, Athlete’s Foot, Calluses, Fungal Nails) – Poor feeling (Neuropathy) – Poor circulation (Peripheral vascular disease) – Improper shoe gear
  9. 9. Hammertoes & Bunion
  10. 10. Equinus
  11. 11. Charcot Foot
  12. 12. Skin Problems - Corns & Calluses
  13. 13. Skin Problems –Ulcerations and Infections
  14. 14. Skin Problems –Dry Cracked Skin
  15. 15. Skin Problem – Advanced Wound Therapy• Dermagraft• If a wound does not decrease by 50% in 4 weeks advanced therapies recommended.• Reduces risk of amputation and infection.
  16. 16. Skin Problem - Nail Disorders
  17. 17. Poor Feeling - Neuropathy• Nerve Fiber Biopsy
  18. 18. Poor Circulation - PAD
  19. 19. Diabetic Shoes – Preventing AmputationsMost patient’s with DiabetesQualify for a pair of Diabetic Shoes each year. • Partial/Complete Amputation • Previous Ulceration • Pre-Ulcerative Callus • Neuropathy with Callus • Poor Circulation • Foot Deformity
  20. 20. Footwear at Home – Preventing Injury• Crocs – wide toe box, seamless interior, silver for antifungal and bacteria and toe cap
  21. 21. Diabetic Socks• Seamless• Reduces friction that can lead to ulceration and wounds• Compression socks if have swelling
  22. 22. Conclusion• Control blood sugar and Hemoglobin A1C• Dangers of neuropathy and “gift of pain”• Risk Stratification – No Neuropathy – Yearly – Neuropathy – 2 x Year – Neuropathy, PVD and/or deformity – 4 x Year – Previous Ulcer or Amputation – 6 x Year
  23. 23. Conclusion• High pressure areas, risks and offloading• Proper foot care (reverse of Pressure Stat)• Daily self-examination and monitoring feet• Review of current medications• Next Exam

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