December 2021 Tip of the Month

Considerations for Foot Care in Diabetes Patients

Patients with diabetes should have an annual physical examination to assess for skin integrity, deformities, vascular perfusion including pedal pulses, and neuropathy/loss of protective reflexes.

Additional Considerations for Diabetic Foot Care
 

  • Risk factors for diabetes-related foot ulcers and amputations include poor glycemic control, neuropathy with loss of protective sensation, cigarette smoking, foot deformities, pre-ulcerative corns and callouses, peripheral arterial disease, prior foot ulcer or amputation, visual impairment, and Chronic Kidney Disease (especially dialysis dependence)

  • Ankle-brachial index (ABI) should be ordered in patients with signs or symptoms of PAD

  • All patients, particularly those at increased risk, should be educated regarding general foot care and proper footwear

Treatment
 

  • Patients with neuropathy, increased plantar pressure, or deformities may be treated with well fitted walking and athletic shoes, including extra wide/deep or custom molded footwear

  • If ulcer or PAD present:

    • At least one of the following should also be performed, as available: skin perfusion pressure (>/=40 mmHg), toe pressure (>/=30 mmHg), transcutaneous oxygen pressure (TcP02 >/-25 mmHg)

    • Urgent vascular referral indicated for diabetic foot ulcer with ABI <50 mm Hg, toe pressure <30 mm Hg, or TcP02 <25 mmHg

  • Patients with neuropathy and acute onset of a red, warm, and/or swollen foot or ankle should be rapidly assessed for Charcot joint and, if present, promptly treated

  • Infected wounds are typically polymicrobial, with staphylococci and streptococci being the most common pathogens. Most infections respond to antibiotics directed against these pathogens, though more chronic, severe, and/or previously treated infections may require broader spectrum antibiotics. Referral to a podiatrist, orthopedist, or vascular surgeon may be warranted.

  • Hyperbaric oxygen therapy (HBOT) has not been proven effective in treating diabetic foot infections

 

Source: Mount Sinai Diabetes Care Pathway

 

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