DIABETES: PREVENTATIVE CARE FOR THE HIGH RISK FOOT

Sandra Martin, DPM Associate Clinical Professor Orthopaedic Surgery UCSF/SFGH

SCREENING EXAMINATION

Vascular Neurological Dermatological Musculoskeletal

VASCULAR

Dorsalis Pedis and Posterior Tibial pulses

Vascular

Arterial Filling Time

Normal: 3 seconds Delayed: 6-7 seconds Concern: 10 seconds

VASCULAR

Elevation Pallor Dependant Rubor

VASCULAR

Venous Stasis

Edema Varicosities Stasis Dermatitis

VASCULAR

Doppler evaluation

NEUROLOGICAL

Protective Threshold Assessment

5.07 Semmes-Weinstein monofilament Start distal and work proximally Forced choice method

DERMATOLOGICAL

Hyperkeratoses Blisters Ulcers Irritation

ULCERATIONS

Neuropathic Vascular

Arterial Venous

MUSCULOSKELETAL

Deformities with overlying hyperkeratoses Equinus Varus

SHOEGEAR

Shoes rarely fit the shape of the foot Draw outline of foot and place shoe over the drawing very effective

ASSESSING FOOT RISK

Loss of protective sensation Deformity History of ulceration Blood flow

Foot Risk Categorization

Rating 0 1 2 3 LOPS no yes yes yes Deformity maybe no yes yes Hx of Ulcer no no no yes

Protocols for Preventative Care

Rating 0 1 2 Shoes OTC Inserts No Follow up

Q 6 months PCP OTC No Q 3 months PCP Extra Depth PRN plantar Q 1-3 months POD Or Custom lesions Extra Depth PRN plantar Q 1-3 months POD Or Custom Lesions

CHARCOT ARTHROPATHY

Neuroarthropathy Forefoot, midfoot, rearfoot, ankle 3 Phases

Acute Consolidation Remodeling