1. Diabetes and Your Feet A Brief Overview Dr. John Kadukammakal, DPM, AACFAS

2. Background Born & raised in Philadelphia, PA. Medical School @ Temple University 3 year surgical training at Crozer Keystone Health System in Chester, PA. Office Location: Richmond Medical Park 2008 Bremo Road Suite 100, Richmond, VA. 23226 804-285-3933

3. Diabetes Statistics (2011) Nearly 25.8 million people, or 8.3 % of the U.S. population, have diabetes 18.8 million people have been diagnosed 7 million people are still undiagnosed

4. Categories of Diabetes Type 1 (Insulin Dependent) Type 2 Non-insulin Dependent Diet Controlled Pre-Diabetic ???

5. Diabetes – A Systemic Issue Not only affects your blood sugar level Not only affects your blood sugar level Affects major organs Affects major organs Brain Brain Heart Heart Kidneys Kidneys Eyes Eyes Feet!!!!! Feet!!!!!

6. Diabetes & the Feet Diabetes can cause : Delayed Healing Lower Extremity Edema (Swelling) Also seen with HTN, Kidney Issues, Venous Insufficiency PVD (Peripheral Vascular Disease) Wounds/Ulcers Charcot Deformity

7. Prevalence of Ulcers Up to 25 % of those with diabetes will experience an ulcer or wound at some point. Amputation rates can be reduced by 45 to 85 % with a comprehensive foot care program. Without proper treatment, ulcers can quickly escalate into amputation.

8. Diabetic Foot Wounds

10. Charcot Foot

12. Diabetic Neuropathy Disease of the nerves in legs and feet Cause nerves to misfire & miscommunicate Can result in burning, tingling, electric shocks, bee- stings Can happen if blood sugar is high or normal Can be treated with good sugar control and medication if needed

13. What is a Podiatrist? A specialist trained to treat and manage disorders of the foot and ankle.

14. Job of a Podiatrist Perform thorough Foot Examinations Perform thorough Foot Examinations Check circulation, sensation, etc. Check circulation, sensation, etc. Trim toenails, corns, calluses Trim toenails, corns, calluses Correct foot/ankle deformities either surgically or conservatively Correct foot/ankle deformities either surgically or conservatively Hammertoes, Bunions, Flat feet, etc. Hammertoes, Bunions, Flat feet, etc. Manage Neuropathy Manage Neuropathy

15. For any foot/ankle problems For any foot/ankle problems If Diabetic & controlled If Diabetic & controlled At least twice a year At least twice a year If Uncontrolled Diabetic If Uncontrolled Diabetic Every 3 months Every 3 months When to see a Podiatrist?

16. Pedicures Are they wrong? Are they wrong? What should I get done? What should I get done? What to look out for? What to look out for?

17. Shoe gear What kind is the best? What kind is the best? Depends on the level/type of activity Depends on the level/type of activity What to look for in a shoe? What to look for in a shoe? Are flip-flops bad? Are flip-flops bad?

18. Diabetic Shoes Shoes that are wider and deeper than regular shoes Shoes that are wider and deeper than regular shoes Inserts are made from mold of your feet Inserts are made from mold of your feet Come in a wide variety of styles Come in a wide variety of styles One pair per calendar year is covered by Medicare…and some private insurances One pair per calendar year is covered by Medicare…and some private insurances

19. Diabetic Shoes

20. How To Manage Your Feet Perform Daily Foot Inspections Perform Daily Foot Inspections Moisturize twice a day (except in between your toes) Moisturize twice a day (except in between your toes) Coco Butter, Nivea Cream, Eucerin Cream, Lubriderm Coco Butter, Nivea Cream, Eucerin Cream, Lubriderm Do not walk barefoot!!! Do not walk barefoot!!! No bathroom surgery!!!! No bathroom surgery!!!! Socks (white cotton) Socks (white cotton) Inspect Shoes…& rotate them Inspect Shoes…& rotate them COMMON SENSE!!!! COMMON SENSE!!!!