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Management Strategies for the Diabetic Foot

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Cesar Carmona

on 3 October 2014

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Transcript of Management Strategies for the Diabetic Foot

Preventive Footwear
Muscoloskealetal Deformity
Neurologic Assessment
Vascular Assessment
Contributing Factors to the "Diabetic Foot"

F-Scan Assessment

F-Scan Evaluation
Vascular Assessment
Diabetes is a disorder of metabolism

After digestion, glucose passes into the blood stream where it is used for energy.

For glucose to get into cells, insulin must be present.

In people with diabetes, the pancreas either produces little or no insulin.

The body loses its main source of fuel.

Diabetes Overview
Muscoloskelatal Deformity
Complication Prevention
Brandon Slade, DPM
February 12th, 2014

Diabetic Foot Risk and Screening
Any Questions?
Importance of Risk Analysis
Frequent evaluation of the diabetic foot is important to reduce chance of complications.
Diabetic patients have a 25% lifetime risk of developing a foot ulcer.
If left untreated, foot ulcers can lead to lower limb amputation.
Foot amputations are preventable with early recognition and therapy!
Diabetic patients go through multiple stages of complications which can ultimately result in amputation.
Diabetes and Lower
Extremity Amputation

Diabetic Foot
Foot Ulcer
Compromised blood flow

Peripheral neuropathy

Structural deformity

Lack of hygiene

Lack of protective footwear
Palpable artery flow exam.
Doppler ultrasound exam.
Shiny, thin, atrophic skin.
Decreased hair growth.
Dependent rubor.
Skin integrity, ulceration, necrosis.
Decreased immune response.
Decreased healing potential.
Semmes-Weinstein monofilament pressure test.
Tuning fork vibration test.
Ipswich touch exam.
Dry, cracked, thickened skin.
Hammertoes, metatarsal prominence.
Increased plantar pressure.
Foot injury/ulceration.
Motor strength test.
Osseous deformity check.
Range of motion check.
Areas of erythema, blistering, and callusing.
Hammertoe, wide foot, boney prominence.
Increase plantar pressure leading to shoe irritation.
Foot ulceration
Group 0 -Properly fitting footwear
Patient Status:
Low Risk.
No neuropathy.
No deformity.
Annual foot examination.
Properly fitting footwear.
Patient Status:
Group 1
No neuropathy
Group 2
+/- Deformity
+/- Ulcer
Semi-annual foot exam.
Accommodative or prescriptive footwear.
Foot exam every 3-6 months
Prescriptive footwear
Custom Accommodative Orthotics
Scan Patients Foot
Molds From Foot Scan
Hard Plastic Base
Specific Patient Accomodations
Medicare Coverage
Must meet all 3 conditions for Medicare covered therapeutic shoes and inserts.
Must have diabetes.
Must have at least 1 of the following conditions in 1 or both feet:
Partial or complete amputation.
Past foot ulcers.
Calluses that could lead to foot ulcers.
Nerve damage because of diabetes with signs of problems with calluses.
Poor circulation.
Deformed foot.

Medicare Coverage
You are being treated under a comprehensive diabetes care plan and need therapeutic shoes and/or inserts because of diabetes.

Medicare also requires the following:
A podiatrist or other qualified doctor prescribe the shoes.
A doctor or other qualified individual like a podorthist, orthotists, or prosthetist fit and provide the shoes.
Additional Ulcer Prevention Tips
Wear comfortable shoes that fit well and protect your feet.

Shake out your shoes and feel the inside before wearing.

Wear clean, dry socks.

Inspect feet daily.

Gently wash your feet in lukewarm water.

Moisturize your feet, but not between your toes.
Additional Ulcer Prevention Tips
Never treat corns and calluses yourself.

Cut nails carefully.

Keep the blood flowing to your feet.

Never walk barefoot.

Get periodic foot exams.

Take care of your diabetes.

Keep feel warm and dry.
Neurologic Assessment
Abnormal Pressure and Orthotics
High pressure areas of contact between shoe and foot.
Unloaded plantar pressure leads to irritation.
Foot ulceration
Dynamic pressure, force, and timing information of gait.
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