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. Complications: Diabetes MellitusFoot conditions
IV. Management: General Foot Care
- Self foot exam daily
-
Foot examined regularly at physician visits
- Perform Peripheral Neuropathy Testing
- Check for pedal pulses
- Evaluate and aggressively treat new Foot Wounds
- Avoid foot Trauma
- Do not walk barefoot (wear shoes in and out of the house)
- Cut nails carefully
- Avoid excessive heat or chemicals
- Avoid hydrogen peroxide
- Avoid Iodine
V. Management: Shoe selection and modifications
- Obtain well-cushioned walking shoes
- Shoes should have adequate room in toe box
- Consider custom molded shoes
- Break in a new shoe gradually
- Reduce pressure points
- Cushioned insole
- Custom Orthotic
VI. Management: Consider corrective foot surgery for deformities
- Hammertoe
- Metatarsal head resection
- Achilles tendon lengthening
