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The prevalence of diabetes mellitus has been increasing in recent decades. According to the American Diabetes Association, there are approximately 20.8 million people with diabetes in America, which is about 7% of the population. One of the most common complications among the diabetic population is foot problems. The complications can range from diabetic peripheral neuropathy, which is a decrease in sensation in the feet, to gangrene foot infection. Foot infections are a common cause of hospitalizations among diabetic patients.
The best way to treat diabetic foot pathology is prevention. Preventing a diabetic foot problem requires cooperation between the patient and the patient’s physicians. The American Podiatric Medical Association recommends annual routine comprehensive diabetic foot evaluation be performed by a podiatrist or foot specialist. The evaluation will consist of checking blood flow, sensation, degree of deformities, and possible presence of infection in the feet. Depending on the results of the examination, the podiatrist or foot specialist can determine a course of therapy and recommend a frequency for the follow- up examination.
The presence or absence of foot sensation is one of the most importance risk factors for a diabetic patient. A podiatrist can use a tool called a Semmes Weinstein 5.07 Monofilament to check for feet sensation. If a patient is able to feel the monofilament, the risk of developing a foot ulceration or infection is decreased. The next step of the evaluation is to determine the status of the blood flow to the feet. There are two places where a foot specialist can evaluate your blood flow easily. The risk of developing foot pathology or even being able to heal any type of foot problems improves if a diabetic patient has palpable pulses in the feet. Bony deformities or prominences are common foot complications among any population; these foot problems can cause greater risk of developing foot ulceration and infection for the diabetic patient and should be monitored closely.
The University of Texas Health Science Center in San Antonio Podiatry division has developed a diabetic foot classification and the recommended treatment plans for each classification. If a diabetic patient is able to feel sensation in their feet, they can be monitored on an annual basis. However, if the foot sensation is absent or decreased, a diabetic’s risk of developing foot problems nearly doubles. If a bony deformity, such as a bunion, hammertoe, or bone spur, is accompanied with the absence of foot sensation, the risk of a foot ulcer or problem increases to 12 times when compared to a diabetic foot patient with intact sensation. These foot deformities can provide areas with an increase in pressure. When these deformity spots are in contact with a shoe, foot ulcers can develop. Patients with adequate blood flow to the lower extremities may want to consider prophylactic foot surgery to reduce the foot deformities. The presence of infection can significantly increase the chance of foot problems. Simple infections, such as arising from ingrown toenails to abscess, need to be treated with antibiotics or/and a surgical procedure.
Blood flow is the other important factor in evaluating the diabetic foot. Evaluation of the foot blood flow can be done with a simple clinical exam to invasive studies. A significant decrease in blood flow secondary to vascular disease can cause gangrene and delay healing of any foot ulceration. A podiatrist or foot specialist can refer a diabetic patient to the appropriate vascular surgeons if any blood flow problems are detected.
The most important person in a diabetic foot treatment plan is the patient. All diabetic patients need to monitor their feet daily. They should see all their physicians on a regular basis. They should monitor for any open lesions, blisters, or infections and notify their podiatrist or foot specialist immediately if problems are noted. A good working relationship between the patient and the physician can significantly decrease the development of foot problems, and help to treat the problems appropriately and promptly if such conditions arise.