Shaun White 307 High Street T: F:

The Diabetic Foot: Why do we bother?

The Diabetic Foot

UT Texas Risk Classification for Ulceration Category 0 –No neuropathy Category 1 –Neuropathy –1.7 times more likely to develop an ulcer Category 2 –Neuropathy with deformity –12.1 times more likely to develop an ulcer Category 3 –History of pathology –36 times more likely to develop an ulcer Categories 4-6 –Active pathologies – (eg ulceration, infection, Charcot foot, ischaemia) (Armstrong, 1995)

BASIC FOOT ASSESSMENT CHECKLIST Tingling/Numbness/ Burning/ Shooting pains

Vascular Assessment: Pulse examination Dorsalis PedisPosterior Tibial 1.Dorsalis Pedis absent in around 20% of Healthy Individuals Active Podiatry will always conduct Doppler Ultrasound 3.ABI (Ankle Brachial Index)– can be of limited value due to arterial calcification in people with diabetes/elderly.

Screening – Peripheral Neuropathy Light touch 10 g Semmes-Weinstein monofilament Podiatrist test 10 sites –A. Apex 1/3/5 toes –B. Plantar MTPJ’s of 1/3/5 –C. 2 x medial longitudinal arch –D. plantar heel –E. Dorsum of foot Why do we do these 2 tests? What do they tell us? Tips 1.Don’t test over thick skin (callous) 2.People generally lose feeling at periphery – tips of toes first 3.Test apex 1/3/5 and 1 st MTPJ 4.If neuropathic symptoms and concerns re: neuropathy refer to podiatrist for more thorough testing Vibration Perception 1.Graduated tuning fork: >4 = WNL. Test apex of both great toes

Very Important – especially with deformity

Risk Category 3 (36 x more likely foot ulcer) 1.7 times more likely 12.1 times more likely (combined with neuropathy) Why?? High Risk Foot Clinic – Bendigo Health Reviewed at least 3-monthly and complex foot exam annually.

Ingrown toenail, callous, corn, foot pain, footwear advice etc etc GP: Gabepentin / Lyrica Footwear Advice – Extra Depth Shoes

Other Diabetes Considerations

Shaun White 307 High Street T: F: QUESTIONS??