The document discusses the importance of foot health in individuals with diabetes, highlighting the risk of ulcers and amputations resulting from poor circulation, neuropathy, and foot deformities. It provides an overview of common foot problems, their causes, and treatment options, including the necessity of diabetic shoes for eligible patients. Additionally, it covers various conditions such as plantar fasciitis, hammertoe, athlete's foot, and treatment suggestions for each condition.

1. Amputation Prevention – Keeping Your Feet Healthy With Diabetes Don Pelto, DPM Central Massachusetts Podiatry, PC Worcester, MA

2. Why should I listen? You or a loved one will probably develop diabetes during your lifetime 1-4% of people with diabetes get ulcers every year and 15-25% will get one in their lifetime 15% of ulcers lead to amputation 85% of amputations start as ulcers 45% of people with an ulcer will die within 5 years

3. Poor Circulation - PAD

4. Neuropathy

5. Neuropathy Neuropathy Medication Oral Topical Medication ENFB (Epidermal Nerve Fiber Biopsy)

6. Foot Deformity - Bunions and Hammerotes

7. Foot Deformity – Callous / Corn Thickened skin caused by chronic rubbing or irritation of a bony prominence by the ground or shoe gear

8. Callous / Corn Treatment Trimming Callus Callus Cream & Pumice Bar Padding Decreasing friction Don't use acid pads

9. Diabetic Ulcer

10. Diabetic Ulcer

11. Diabetic Ulcer 4 Reasons Why Won’t Heal High Blood Sugar Poor Circulation Deeper Infection Walking on Wound

12. Diabetic Ulcer Spencer SA. Pressure relieving interventions for preventing and treating diabetic foot ulcers. Cochrane Database of Systematic Reviews 2000, Issue 3. Art. No.: CD002302. DOI: 10.1002/14651858.CD002302.

13. Diabetic Ulcer Ubbink DT, Westerbos SJ, Evans D, Land L, Vermeulen H. Topical negative pressure for treating chronic wounds. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD001898. DOI: 10.1002/14651858.CD001898.pub2.

14. Diabetic Ulcer Callus Diabetic shoes Ulceration VAC Debridement Dermal Skin Substitute Platelet Rich Plasma

15. Charcot Foot Edwards J, Stapley S. Debridement of diabetic foot ulcers. Cochrane Database of Systematic Reviews 2010, Issue 1.

16. Diabetic Shoes Most patient’s with Diabetes Qualify for a pair of Diabetic Shoes each year. Partial/Complete Amputation Previous Ulceration Pre-Ulcerative Callus Neuropathy with Callus Poor Circulation Foot Deformity

17. Common Foot Problems For people with and without diabetes

18. Plantar Fasciitis / Heel Spur Inflammation and partial tearing of a ligament band Spur may be present Pain first thing in morning

19. Plantar Fasciitis Treatment New shoes Ice NSAIDs Night Splint Stretching vs Deep Tissue Massage

20. Plantar Fasciitis Treatment Steroid Injection 25G Needle 3cc Syringe 1cc 1% Lidocaine 1cc 0.5% Marcaine 0.5cc Kenalog 0.5cc Dexamethasone

21. Flat Feet Congenital or acquired Pain may occur in the feet, ankles, knees or back

22. Flat Feet Treatment Supportive Shoes Orthotics Arizona Brace

23. Morton’s Neuroma Compressed Nerve Most often 3 rd interspace Burning / pain on the ball of the foot or toes r/o stress fracture, metatarsalgia

24. Morton’s Neuroma Treatment Wide shoes No high heel shoes NSAIDs Physical Therapy Orthotics Metatarsal Pad Steroid Injection Sclerosing Injection 4% 48cc 0.5% Marcaine with epi 2cc Dehydrated Alcohol

25. Hallux Valgus Painful bump secondary to increase IM angle Poor biomechanics Hurts in shoes Usually bump pain vs joint pain Wider shoes help Orthotics slow or stop progression and pain

26. Hallux Valgus Treatment Radiographs Wider shoes Padding, Bunion Bra Trimming Keratoma Corticosteroid Injection Bump vs Joint Orthotics slow or stop progression and pain

27. Tailor’s Bunion / Bunionette Bony deformity which is located on the outside part of the foot. The bump, bunionette or Tailor’s Bunion, can become very painful due to shoe irritation. Note prominent 5 th metatarsal head

28. Hallux Rigidus Arthritis of 1 st MPJ Poor biomechanics Painful to walk

29. Hallux Rigidus Treatment Cortisone injection Physical therapy NSAIDS Orthotics

30. Hammertoe Deformity Digital contracture can be flexible or rigid in nature Usually PIPJ May have MPJ dorsiflexion May have callus Pre-ulcerative in patients with diabetes

31. Hammertoe Treatment Debridement Padding Shoe gear change

32. Athlete's Foot Fungal infection (Dermatophyte). May occur anywhere on the foot and may burn and/or itch The affected areas of skin will often peel or may have small blisters

33. Athlete's Foot Treatment Topical Antifungal – Cream vs Gel Topical Steroid May be dermatitis Biopsy if not responding

34. Plantar Wart Human Papilloma Virus (HPV) Contagious Usually plantar on foot

35. Verruca Treatment Debridement Chemocautery Laser Topical treatments Oral Cimetidine for pediatric usage (30-40Mg/Kg in 3 divided doses) Liquid Nitrogen not very effective on thick plantar foot skin

36. Ganglion Cyst Benign soft tissue mass which arises from a weak area in a tendon lining or joint Cyst is often filled with a gelatinous fluid Cyst may change size depending on irritation

37. Ganglion Cyst Treatment Aspiration Cortisone Injection Trauma Pressure

38. Eczema/Fissures Skin inflammatory condition Worse in winter Make sure not ulceration

39. Ezema/Fissure Treatment Cream Pumice Stone Off-loading Boot

40. Eczema/Fissure Treatment

41. Ingrown Nails/Paronychia Painful to edge of nail with pressure or tight shoes Erythema, edema, purulent exudate

42. Ingrown Nail Treatment Antibiotic Massaging Nail Edge I&D Phenol & Alcohol (P&A)

43. Onychomycosis Dermatophyte Often seen with skin manifestations Usually acquired but may be inherited May be caused by trauma

44. Onychomycosis Treatment Debridement Topical/Oral Antifungal Laser Nail Avulsion Matrixectomy Nail Biopsy

45. Fungal Laser Kills the pathogens that cause toenail fungus (Onychomycosis). Painless-no anesthesia needed. No side effects. Does not harm the nail or skin. Usually only one treatment required. Shoes and nail polish can be worn immediately after treatment.

46. Nail Injury Chronic injury (i.e. athletic activities) Isolated injury (trauma) Nail bed laceration

47. Nail Injury Treatment Watch and wait Nail avulsion Puncture

48. Subungual Exostosis Bone and cartilage growth under the great toe nail Pain may arise if pressure is placed over the area

49. Subungual Exostosis Treatment Shoe Modification Toe Cap Nail Avulsion Cortisone Injection Exostectomy

50. Haglund’s Deformity / Retrocalcaneal Exostosis Prominent bone on the back of the heel. Back of the heel is irritated by shoes and activity.

51. Haglund’s Deformity / Retrocalcaneal Exostosis Treatment Open Backed Shoes Steroid Injection around Bursa Orthotics

52. Fractures 5 th Metatarsal – Difficulty healing Digital Calcaneus Stress Fracture

53. Fracture Treatment Surgical Shoe CAM Walker Bone Stimulator Buddy Taping MRI vs CT

54. Thank You Don Pelto, DPM Central Massachusetts Podiatry, PC Worcester, MA [email_address] (508) 757-4003