LCHM Summer 2017 - 5
L C M E D S O C .O R G
It all starts with a comprehensive foot exam that
according to the American Diabetes Association
should be performed annually. The purpose of
the exam is to identify risks before they lead to
a potentially serious problem.
One important aspect of the foot exam is to
determine if there is a loss of protective sensation.
The most common baseline test is performed
when a nylon filament is applied to the bottom
of the foot to see if the patient can feel it. There
are other tests to check for vibration sensation
as well as pain and temperature. Without intact
sensation, a diabetic is at risk for injury not only
from stepping on sharp objects but also from
temperature extremes. A day at the beach could
result in a severe burn from a hot pavement or
sand. There is the possibility of frostbite during
the cold winter months. Identifying this risk will
help direct more attention on hazardous situations
with a focus on preventing injury.
A good visual inspection of the feet will help
identify open areas and breaks in the skin as well
as any sign of infection. Corns and calluses are
a sign of increased pressure which can lead to
skin breakdown. Any time there is a break in the
skin, there is a risk for infection. Diabetics must
understand the importance of a daily visual check
of their feet. They can identify a potential problem
early when it first occurs.
Circulation to the feet is vital for tissue integrity. If the pulses in the feet are not palpable, a
handheld Doppler can be used to see if blood is
flowing. There is also an index (ABI) that is used
to predict healing potential. Skin texture and color
is a reflection of the circulation status. Absence of
hair on the feet and legs can be a result of poor
circulation. There are additional tests which can
be ordered when needed. Exercise and walking is
important but any time a patient is experiencing
pain in their legs and difficulty walking they should
bring this to the attention of their doctors as it
may be the result of poor circulation.
best treatment for an active Charcot process
is early, complete non-weight bearing before
the foot undergoes changes.
HERE ARE THE
1. Check your feet every
day. If you can't do it, find
someone who will.
2. Wash feet daily and dry
3. Apply lotion to feet daily
but not between toes.
4. Shake out shoes before
putting them on each day.
5. Avoid any sharp cutting
of corns and calluses.
6. If not at risk , trim normal nails straight across.
7. Seek professional help
early when problems arise.
8. Protect your feet with
the appropriate footwear.
9. Barefoot ambulation is
10. Ask questions if you
Footwear is important for the diabetic foot.
Shoes need to be non-irritating and there needs
to be enough space for any abnormalities. Diabetic-approved extra depth shoes are essential
in many cases and now more acceptable in
appearance. Sometimes special custom molded
shoes are needed due to the severity of the deformities. There are also many types of custom
foot orthotics which help address function
as well as offload problem pressure areas. A
Comprehensive foot exam should include an
evaluation of all of the above mentioned along
with recommendations for footwear.
In addition, risks for performing self-care
should also be determined by the evaluating
specialist. Can the patient reach their feet and
safely use an instrument? Does the patient have
reasonable eyesight to see what they are doing?
Has the patient injured himself or herself in
the past? Does the patient have any of the
above-mentioned risks making self-care inadvisable? Often instruments used in the home or
by non-professionals are not clean or sterilized,
posing additional risk even if the patient can
see, reach and clip their own nails. The most
important aspect of the comprehensive visit is
to determine if further evaluation and testing is
indicated. It is also wise to recommend periodic
professional care for patients at risk.
Dr. Raymond A. Fritz Jr. is a podiatric physician and
the president of Allentown Family Foot Care. AFFC
has been serving patients of the Lehigh Valley for 26
years. Dr. Fritz is a graduate of Muhlenberg College
and the Temple School of Podiatric Medicine. Other
members of this group practice are Drs. Lora Baker, Ann
Anderson, Kevin Short and Phil Jimenez. This practice
specializes in the medical and surgical treatment of
the foot and ankle.
Foot deformities can create difficulties with shoe
fit. Bunions, hammertoes and any bony irregularities can result in skin irritation. These deformities
cause shoes to irritate overlying skin, resulting
in blisters, corns, calluses and even ulcerations.
Charcot foot changes can result in severe foot
deformities if not immediately identified. The
SUMMER 2017 | Lehigh County Health & Medicine 5
Table of Contents for the Digital Edition of LCHM Summer 2017
LCHM Summer 2017 - 1
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