The Diabetic Foot
Plantar Offloading of the Diabetic Foot The feet are the foundation of the posture and must accept a lifetime of weightbearing stress. Biomechanics, body weight, and activity level determine the location and timing of areas of potential breakdown. It is necessary to disperse the plantar weightbearing forces away from high stress areas in order to
Risk Factors for Amputation The risk factors for lower extremity amputation are classified into primary and secondary. The primary risk factors include peripheral neuropathy, peripheral vascular disease, structural and functional foot deformities, infection, and ulceration. The secondary risk factors include obesity, impaired vision, improper footwear, lack of a home-based support system, and apparent noncompliance on
The Physician Foot Evaluation Physicians treating diabetic individuals should obtain a baseline history when it comes to examining the feet of diabetic patients. He or she should then monitor the feet in order to prevent ulcers and amputations and to maintain quality of life. A history of foot and shoe fit problems and quality of
Historically, peripheral arterial disease has been considered the most common complication observed in diabetic lower extremities. However, it is now accepted that the distal symmetric sensory, autonomic, and motor polyneuropathy occurs in up to 60% of patients with long-standing disease. Furthermore, insensitivity coexists with diabetic foot wounds more than 80% of the time. Peripheral nerve
The importance of the physician’s role in examining and assessing the diabetic foot is hard to overstate,1 yet studies have shown that primary care physicians are rarely performing foot examinations on their diabetic patients during routine visits. Uncontrolled diabetes is the cause of 60% of the 67,000 non-traumatic amputations encountered annually in the United States.