Diabetic Foot Care

1. See Also
   1. Diabetes Mellitus
   2. Foot Wound
   3. Diabetic Neuropathy
2. Evaluation: Diabetic Foot Classification
   1. Risk 0: No loss of protective Sensation, peripheral arterial disease or deformity
      1. Foot care Patient Education including footwear (see below)
      2. Follow-up every 12 months for foot exam including Diabetic Neuropathy Testing
   2. Risk 1: Loss of protective Sensation
      1. Prophylactic surgery for foot deformities (e.g. Hallux Valgus) not accomodated by shoe wear
      2. Consider prescription footwear
      3. Follow-up every 3-6 months for foot exam including Diabetic Neuropathy Testing
   3. Risk 2: Peripheral Arterial Disease
      1. See Peripheral Arterial Disease for management
      2. Consider prescription footwear
      3. Consider vascular surgery Consultation
      4. Follow-up as often as every 2-3 months for specialist evaluation
   4. Risk 3: Diabetic Foot Ulcer or prior amputation
      1. Follow-up as often as every 1-2 months with foot specialist
   5. References
      1. Boulton (2008) Diabetes Care 31(8): 1679-85 [PubMed]
3. Complications: Diabetes MellitusFoot conditions
   1. Diabetic Foot Infection
   2. Diabetic Foot Ulcer
   3. Charcot Foot
   4. Diabetic Neuropathy
4. Management: General Foot Care
   1. Self foot exam daily
      1. Use a mirror if difficult to visualize underside of foot
   2. Foot examined regularly at physician visits
      1. Take off shoes and socks at every visit
      2. Perform Peripheral Neuropathy Testing
      3. Check for pedal pulses
   3. Use skin Emollients on feet (except in webspaces)
   4. Evaluate and aggressively treat new Foot Wounds
      1. Address calluses and corns early and eliminate pressure points from shoes to prevent future calluses
      2. Treat Tinea Pedis and Onychomycosis
   5. Avoid foot Trauma
      1. Do not walk barefoot (wear shoes in and out of the house)
      2. Cut nails carefully
         1. Cut nails straight across to prevent Ingrown Toenails
         2. Avoid pedicures in Diabetic Neuropathy (and if not avoided, notify nail technician about Diabetes Mellitus)
      3. Avoid excessive heat or chemicals
         1. Avoid Hydrogen Peroxide
         2. Avoid Iodine
5. Management: Shoe selection and modifications
   1. Obtain well-cushioned walking shoes
   2. Shoes should have adequate room in toe box
   3. Consider custom molded shoes
   4. Break in a new shoe gradually
   5. Reduce pressure points
      1. Cushioned insole
      2. Custom Orthotic
6. Management: Consider corrective foot surgery for deformities
   1. Hammertoe
   2. Metatarsal head resection
   3. Achilles tendon lengthening
7. References
   1. (2021) Presc Lett 28(7): 41
   2. Frykberg (2002) Am Fam Physician 66(9):1655-62 [PubMed]
   3. Frykberg (2000) J Foot Ankle Surg 39:S46 [PubMed]