ADVANCED FOOT AND ANKLE SPECIALISTS, PA
Jay S. Weingarten, DPM, FACFAS, FACFAOM
Podiatric Physician and Surgeon
Board Certified Physician – Treating Pediatrics to Geriatrics
The Diabetic Foot
Patients with diabetes must be made aware that their feet can be affected by
the disease. The feet and lower extremities are examples of end organs that
can develop complications from diabetes. Because of macro and
microangiopathy, the feet may receive less blood flow. This ischemia puts
the foot at risk, especially when stressed by extremes in temperature,
breaks in skin integrity, and infection. Sensory, motor, and autonomic
neuropathies may develop which can lead to a loss of sensation, muscle
atrophy, and poor tissue quality. Neuroathropathy (Charcot Joint) may also
occur, leading to subluxations (major joint dislocations and degeneration).
Also, patients with diabetes have poor cellular response to bacterial
infections, thus placing the diabetic foot at high risk for infection. Minor cuts,
abrasions, or foot ulcerations can lead to concerning situations if infection is
present.
A thorough lower extremity examination is necessary for patients with
diabetes. In the initial evaluation, it is very important to obtain a detailed
history and physical exam. A though vascular exam must be performed. If
there are non-palpable or diminished pulses, further non-invasive vascular
studies should be considered. A meticulous neurologic exam should be
performed to establish the presence of neuropathy. Special attention is given
to the sensory exam to ascertain the level of protective threshold (the ability
for the patient to detect noxious stimuli).
Based on the clinical exam and risk category placement, a treatment
protocol is established. Treatment of the diabetic foot focuses on prevention.
A multidiscipline team approach is typical, including but not limited to the
patient's internist or endocrinologist, foot specialist, vascular surgeon, and
infectious disease specialist. The overall goal is to keep the patient
ambulatory, out of the hospital, and ulcer and infection free.
Educating patients with diabetes regarding foot care is paramount to the
overall treatment. They must be made aware of how their diabetes can
affect their feet. The patients (and/or care takers) must recognize early
warning signs of problems and inspect their feet everyday. Based on their
foot risk category placement, patients with diabetes need to see their foot
specialist on a regular prescribed basis.
The following list is an example of what patients need to know to prevent
tissue breakdown and infection:
• Do not attempt to treat corns, calluses, toenails, or other foot problems
oneself. No "bathroom surgery".
• Never use chemical agents or medicated pads (corn removers) as these
agents contain acids that can erode the skin.
• Inspect the feet and legs daily for any unusual swelling, discolorations,
areas of increased temperature, or breaks in the skin, paying particular
attention to the areas between the toes and around the toe nails.
• Never go barefoot (including inside the house).
• Socks should be worn with shoes at all times to reduce friction, provide
insulation, prevent soiling of the foot, and absorb perspiration. Socks
should be made of cotton, wool, or a blend (not 100% synthetic) and
preferable white, non-mended, and without holes.
• Shoe styles should be discussed with and inspected by one's foot specialist.
• Inspect the inside of shoes for any sharp or loose objects before placing on
feet.
• Avoid exposing feet to temperature extremes. Bath water should be
checked with a thermometer or hand (if good sensation in hands).
Never warm cold feet with hot water bottles or heating pads.
• Do not apply creams or ointments between the toes.
• Be able to recognize early signs and symptoms of infection, including
redness, swelling, and drainage. If any of these symptoms are noted
please call your foot doctor immediately or go the nearest emergency
room.
Many hospital admissions and non traumatic lower extremity amputations
can be avoided with early recognition and treatment of diabetic foot
problems. By providing foot health care, including prescribing oral and
topical medications (i.e., for uncomfortable neuropathy, "burning feet"),
accommodative orthoses, proper shoeing, and education, the foot care
specialist can help the patient avoid the complications of infection and tissue
loss. The goal of lower extremity care in patients with diabetes is to maintain
ambulation with two full limbs and ten toes for the patient's entire life.
1233 SE Indian St., Suite 102, Stuart, FL 34997
tel. 772-223-8313, fax 772-223-8675
1106 W Indiantown Rd, Suite 4, Jupiter, FL 33458 tel. 561-744-6683, fax 561-744-7033