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

2. 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

3. 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

4. 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

5. Forefoot amputations

6. Bilateral Forefoot amputations

7. Untreated plantar callous

8. 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

9. Forefoot amputation

10. 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

11. 3 Minute Diabetic Foot Exam
Patient History (1 minute)
Physical Exam (1 minute)
Patient Education (1 minute)

12. 3 Minute Diabetic Foot Exam
Patient History (1 minute)
Previous foot ulcer/amputation
Prior angioplasty, stent or bypass. Cardiac or leg!
Smoking
Diabetes control

13. 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

16. 3 Minute Diabetic Foot Exam
Neurologic Exam
Ipswich Touch Test

17. Ipswich Touch Test

18. 3 Minute Diabetic Foot Exam
Musculoskeletal Exam
Obvious deformities
Full range of motion of joints
Midfoot hot and red or inflamed

19. Acute Charcot Foot

20. Chronic Charcot Foot

21. 3 Minute Diabetic Foot Exam
Vascular Exam
Decreased hair growth
Palpable dorsalis pedis and posterior tibial pulses
Temperature difference

23. 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

24. Roofing nail stuck in shoe

25. Scalding Hot Water

26. Second Amputation

27. 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

28. No man is an island…..