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. Management: General
   1. Optimize glycemic control
   2. Optimize Peripheral Arterial Disease Management
   3. Tobacco Cessation
   4. Prevent progression of Diabetic Nephropathy
4. Management: Foot Care
   1. Self foot exam daily
      1. Use a mirror if difficult to visualize underside of foot
      2. Check for Foot Pain, focal tenderness, redness, abrasions, infections
   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. Keep feet clean and dry
      1. Wash and dry feet after Exercise and bathing
      2. Wear socks and change sock if moist
   4. Use skin Emollients on feet
      1. Avoid applying in the webspaces
      2. Apply after bathing
      3. Prevents Blisters, skin cracks and calluses
   5. Evaluate and aggressively treat new Foot Wounds
      1. Address calluses and corns early (e.g. Debridement)
         1. Eliminates pressure points from shoes to prevent future calluses
      2. Treat Tinea Pedis and Onychomycosis
   6. Avoid foot Trauma
      1. Do not walk barefoot (wear shoes in and out of the house)
      2. Check the inside of shoes before placing on feet
      3. Trim nails carefully
         1. Cut nails straight across to prevent Ingrown Toenails
         2. Smooth nails with file
         3. Avoid pedicures in Diabetic Neuropathy (and if not avoided, notify nail technician about Diabetes Mellitus)
      4. Avoid excessive heat or chemicals
         1. Avoid Hydrogen Peroxide
         2. Avoid Iodine
5. Management: Shoe selection and modifications
   1. Obtain well-cushioned walking shoes
      1. Shoes should feel comfortable with adequate room, including space for a cushioned insole
      2. Shoes should have adequate room in toe box (square toe box)
      3. Avoid tight fitting shoes (ideally, limit to 3 to 4 eyes per side)
      4. Break in a new shoe gradually
      5. Replace shoes yearly
      6. Avoid sandals
   2. Reduce pressure points
      1. Cushioned insole
      2. Custom Orthotic
   3. Consider custom molded shoes
      1. Severe Neuropathy
      2. Foot deformities
      3. Poor foot circulation
      4. Foot Ulcers
      5. Amputation history
6. Management: Consider corrective foot surgery for deformities
   1. Hammertoe
   2. Metatarsal head resection
   3. Achilles tendon lengthening
7. Complications: Diabetes MellitusFoot conditions
   1. Diabetic Foot Infection
   2. Diabetic Foot Ulcer
   3. Charcot Foot
   4. Diabetic Neuropathy
8. 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]
   4. Matheson (2021) Am Fam Physician 104(4): 386-94 [PubMed]