Comprehensive Diabetic Foot Examination

Comprehensive Diabetic Footcare Examination

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

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

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

Fasting Blood Sugar• Fast overnight or don’t eat anything for 8 hours• Draw blood to determine amount of blood sugar

Blood Sugar Numbers• Taken at various times during the day with glucometer

Hemoglobin A1C

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

Hammertoes & Bunion

Equinus

Charcot Foot

Skin Problems - Corns & Calluses

Skin Problems –Ulcerations and Infections

Skin Problems –Dry Cracked Skin

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.

Skin Problem - Nail Disorders

Poor Feeling - Neuropathy• Nerve Fiber Biopsy

Poor Circulation - PAD

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

Footwear at Home – Preventing Injury• Crocs – wide toe box, seamless interior, silver for antifungal and bacteria and toe cap

Diabetic Socks• Seamless• Reduces friction that can lead to ulceration and wounds• Compression socks if have swelling

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

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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Comprehensive Diabetic Foot Examination

by Dr. Donald Pelto

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Comprehensive Diabetic Foot Examination Webinar Transcript