II. Evaluation: Diabetic Foot Classification
- Risk 0: No loss of protective Sensation, peripheral arterial disease or deformity
- Foot care Patient Education including footwear (see below)
- Follow-up every 12 months for foot exam including Diabetic Neuropathy Testing
- Risk 1: Loss of protective Sensation
- Prophylactic surgery for foot deformities (e.g. Hallux Valgus) not accomodated by shoe wear
- Consider prescription footwear
- Follow-up every 3-6 months for foot exam including Diabetic Neuropathy Testing
- Risk 2: Peripheral Arterial Disease
- See Peripheral Arterial Disease for management
- Consider prescription footwear
- Consider vascular surgery Consultation
- Follow-up as often as every 2-3 months for specialist evaluation
- Risk 3: Diabetic Foot Ulcer or prior amputation
- Follow-up as often as every 1-2 months with foot specialist
- References
III. Management: General
- Optimize glycemic control
- Optimize Peripheral Arterial Disease Management
- Tobacco Cessation
- Prevent progression of Diabetic Nephropathy
IV. Management: Foot Care
- Self foot exam daily
- Use a mirror if difficult to visualize underside of foot
- Check for Foot Pain, focal tenderness, redness, abrasions, infections
-
Foot examined regularly at physician visits
- Take off shoes and socks at every visit
- Perform Monofilament Foot Sensation Test
- Check for pedal pulses
- Keep feet clean and dry
- Wash and dry feet after Exercise and bathing
- Wear socks and change sock if moist
- Use skin Emollients on feet
- Avoid applying in the webspaces
- Apply after bathing
- Prevents Blisters, skin cracks and calluses
- Evaluate and aggressively treat new Foot Wounds
- Address calluses and corns early (e.g. Debridement)
- Eliminates pressure points from shoes to prevent future calluses
- Treat Tinea Pedis and Onychomycosis
- Address calluses and corns early (e.g. Debridement)
- Avoid foot Trauma
- Do not walk barefoot (wear shoes in and out of the house)
- Check the inside of shoes before placing on feet
- Trim nails carefully
- Cut nails straight across to prevent Ingrown Toenails
- Smooth nails with file
- Avoid pedicures in Diabetic Neuropathy (and if not avoided, notify nail technician about Diabetes Mellitus)
- Avoid excessive heat or chemicals
- Avoid Hydrogen Peroxide
- Avoid Iodine
V. Management: Shoe selection and modifications
- Obtain well-cushioned walking shoes
- Shoes should feel comfortable with adequate room, including space for a cushioned insole
- Shoes should have adequate room in toe box (square toe box)
- Avoid tight fitting shoes (ideally, limit to 3 to 4 eyes per side)
- Break in a new shoe gradually
- Replace shoes yearly
- Avoid sandals
- Reduce pressure points
- Cushioned insole
- Custom Orthotic
- Consider custom molded shoes
- Severe Neuropathy
- Foot deformities
- Poor foot circulation
- Foot Ulcers
- Amputation history
VI. Management: Consider corrective foot surgery for deformities
- Hammertoe
- Metatarsal head resection
- Achilles tendon lengthening