Presentation of information for a comprehensive diabetic foot examination that is used in conjunction with the exam. Healthcare guide to diabetes and your feet can be obtained at www.drpelto.com

1. Comprehensive Diabetic
Footcare Examination

2. What is it?
• An examination to evaluate and determine
risk factors for patient’s with diabetes
performed on regular basis based on
symptoms.
– Diabetes with no risk factors – Yearly
– Diabetes with 1 risk factor – 2x a year
– Diabetes with 2 risk factors – 3x a year

3. What are the risk factors?
• Diabetes with the following
– Foot deformity (Bunion, Hammertoe, Equinus)
– Skin problems (Ulceration, Athlete’s Foot,
Calluses, Fungal Nails)
– Poor feeling (Neuropathy)
– Poor circulation (Peripheral vascular disease)
– Improper shoe gear

4. Initial Information
• Last footcare visit • Doctor treating your
• Last CDFE diabetes (PCP or
• Changes medical Endocrinologist)
history • Last date seen
• Changes to
medications
• New foot concerns

5. Fasting Blood Sugar
• Fast overnight or
don’t eat anything for
8 hours
• Draw blood to
determine amount of
blood sugar

6. Blood Sugar Numbers
• Taken at various
times during the day
with glucometer

7. Hemoglobin A1C

8. What are the risk factors?
• Diabetes with the following
– Foot deformity (Bunion, Hammertoe, Equinus)
– Skin problems (Ulceration, Athlete’s Foot,
Calluses, Fungal Nails)
– Poor feeling (Neuropathy)
– Poor circulation (Peripheral vascular disease)
– Improper shoe gear

9. Hammertoes & Bunion

10. Equinus

11. Charcot Foot

12. Skin Problems - Corns & Calluses

13. Skin Problems –
Ulcerations and Infections

14. Skin Problems –
Dry Cracked Skin

15. Skin Problem –
Advanced Wound Therapy
• Dermagraft
• If a wound does not
decrease by 50% in 4
weeks advanced
therapies
recommended.
• Reduces risk of
amputation and
infection.

16. Skin Problem - Nail Disorders

17. Poor Feeling - Neuropathy
• Nerve Fiber Biopsy

18. Poor Circulation - PAD

19. Diabetic Shoes –
Preventing Amputations
Most patient’s with Diabetes
Qualify for a pair of Diabetic
Shoes each year.
• Partial/Complete
Amputation
• Previous
Ulceration
• Pre-Ulcerative
Callus
• Neuropathy with
Callus
• Poor Circulation
• Foot Deformity

20. Footwear at Home –
Preventing Injury
• Crocs – wide toe box,
seamless interior, silver
for antifungal and bacteria
and toe cap

21. Diabetic Socks
• Seamless
• Reduces friction that
can lead to ulceration
and wounds
• Compression socks if
have swelling

22. Conclusion
• Control blood sugar and Hemoglobin A1C
• Dangers of neuropathy and “gift of pain”
• Risk Stratification
– No Neuropathy – Yearly
– Neuropathy – 2 x Year
– Neuropathy, PVD and/or deformity – 4 x Year
– Previous Ulcer or Amputation – 6 x Year

23. Conclusion
• High pressure areas, risks and offloading
• Proper foot care (reverse of Pressure Stat)
• Daily self-examination and monitoring feet
• Review of current medications
• Next Exam