Shaun White 307 High Street T 5482 2393

Shaun White 307 High Street T: 5482 2393 F: 5480 1324 www. activepod. com. au Email: shaun@activepod. com. au

The Diabetic Foot: Why do we bother? “Every 30 seconds, somewhere in the world, a limb is lost as a consequence of diabetes” The Lancet (cover), November 2005

The Diabetic Foot • At least 7. 0% of Australia’s population have diabetes • Diabetes is a major cause of peripheral neuropathy and peripheral vascular disease • 15% of people with diabetes will develop a foot ulcer • People with diabetes are up to 40 times more likely to have a lower-limb amputation • Around 3400 diabetes related amputations in Australia each year

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 Pedis Posterior Tibial 1. Dorsalis Pedis absent in around 20% of Healthy Individuals 2. Podiatrist @ 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 Vibration Perception 1. Graduated tuning fork: >4 = WNL. Test apex of both great toes 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

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 GP: Gabepentin / Lyrica Footwear Advice – Extra Depth Shoes

Other Diabetes Considerations 1. Charcot Foot 1 a. How does it present 1 b. What can it do to the foot? 2. Offloading – corns, callous and ulcers 2 a. Orthotics (soft & hard) 2 b. Silicon Toe Seperator / Toe Prop 2 c. Footwear 2 d. Removable Walking Boot (Camwalker)

QUESTIONS? ? Shaun White 307 High Street T: 5482 2393 F: 5480 1324 www. activepod. com. au Email: shaun@activepod. com. au