The Diabetic Foot Thomas LeBeau, DPM FACCAS Assistant Professor of Podiatric Medicine University of Central Florida College of Medicine St Augustine Foot & Ankle

The Diabetic Foot Half of people with diabetes don’t know they have it. American Diabetes Assn/ International Diabetes Federation,2012 More than 90% of people with diabetic peripheral neuropathy are unaware they have it. Bongaerts, et al, Diabetes Care, 2013

Cost of Diabetic Foot Ulcers The cost of diabetic foot ulcers is greater than that of the five most costly forms of cancer Barshes, et al, Diab Foot Ankle 2013 The estimated annual US Burden of Diabetic Foot Ulcers is at least $15 Billion Rice, et al, Diabetes Care, 2014 More than half of all foot ulcers (wounds) will become infected, requiring hospitalization and 20% of infections result in amputation. Lavery, Armstrong, et al.  Diabetes Care 2006

Seconds Count Every 7 seconds someone dies from diabetes. Every 20 seconds someone is amputated. International Diabetes Federation / Diabetesatlas.org .Armstrong, et al, Diabetes Care 2013

Forefoot amputations

Bilateral Forefoot amputations

Untreated plantar callous

Podiatric Medical Care Podiatric medical care in people with history of diabetic foot ulcer can reduce high level amputation from between 65% and 80% Gibson, et al, Int Wound Journal, 2013 Podiatry care not only reduces amputation risk, but also dramatically impacts rate of hospitalization and reulceration Gibson, et al, Int Wound Journal, 2013

Forefoot amputation

Coordinated Care Coordinated care by an integrated team is the most important factor leading to better outcomes in amputation prevention. That team includes podiatrists, vascular surgeons, infectious disease specialists, primary care and others

3 Minute Diabetic Foot Exam Patient History (1 minute) Physical Exam (1 minute) Patient Education (1 minute)

3 Minute Diabetic Foot Exam Patient History (1 minute) Previous foot ulcer/amputation Prior angioplasty, stent or bypass. Cardiac or leg! Smoking Diabetes control

3 Minute Diabetic Foot Exam Physical Exam (1 minute) Dermatologic Exam Discolored, ingrown or elongated nails Signs of fungal infection Discolored or hypertrophic skin lesions, calluses or corns Open wounds Inter digital maceration

3 Minute Diabetic Foot Exam Neurologic Exam Ipswich Touch Test

Ipswich Touch Test

3 Minute Diabetic Foot Exam Musculoskeletal Exam Obvious deformities Full range of motion of joints Midfoot hot and red or inflamed

Acute Charcot Foot

Chronic Charcot Foot

3 Minute Diabetic Foot Exam Vascular Exam Decreased hair growth Palpable dorsalis pedis and posterior tibial pulses Temperature difference

3 Minute Diabetic Foot Exam Patient Education (1 minute) Recommend daily foot exam NO BAREFOOT ACTIVITY Even Indoors! Diabetic shoes 90% of recurrent ulcers are due to lack of proper education

Roofing nail stuck in shoe

Scalding Hot Water

Second Amputation

When to refer American Diabetes Association Recommendations Urgent- wounds, vascular compromise, Charcot(hot, red, swollen mid foot), sensory loss High- previous ulcer/amputation, chronic venous insufficiency Moderate-PAD, diminished pulses, swelling or edema Low- Loss of sensation, nonchanging deformity

No man is an island…..