February 22, 2016
See a Podiatrist If You have Diabetes – Part 1
I received several emails after my last blog about seeing a podiatrist saying I was wrong to recommend them. Like any profession, I will acknowledge there are some bad apples in the podiatrist profession. I do at least admit that. I have been fortunate that I have a very good podiatrist and he has served me well.
The American Diabetes Association recommends that all patients with diabetes receive an annual comprehensive foot exam. People with diabetes are at increased risk of developing peripheral neuropathy - loss of sensation in the feet and hands. Foot care can be used as a preventative service and surveillance of abnormalities. A comprehensive foot exam should be done by your primary doctor, certified diabetes educator or podiatrist. I disagree with the ADA and feel that you should see a podiatrist a minimum of twice a year. I personally see my podiatrist four times per year.
If you have recently been diagnosed with Type 2 diabetes or have had diabetes for some time and have not received a comprehensive foot exam, it's important that you schedule an exam - ask your physician at your next appointment. Your doctor should request that you take your shoes and socks off (both feet).
He or she will visually inspect the bottoms of your feet and between your toes to check for ulcers, wounds, fungal infections, and bony abnormalities. Next, he or she will check your feet for pulses, which can be a predictor for blood flow. Lastly, they will conduct a sensation assessment using a 128-Hz tuning fork, 10 g monofilament tool or another device. You will be asked to close your eyes and answer when you feel sensation - either a light pulsating vibration from the tuning fork or a gentle touch of the plastic monofilament tool. If the doctor detects any visual abnormalities such as hammer toes, corns, bunions, hard-thick nails, wounds, cracked skin, fungal infections, you will likely be referred to a podiatrist.
If you have diminished sensation or loss of sensation, you may also be referred to a podiatrist or vascular doctor for further testing to rule out peripheral arterial disease.
A podiatrist is a doctor of podiatric medicine (DPM), also known as a podiatric physician or surgeon. Podiatrists diagnose and treat conditions of the foot, ankle, and related structures of the leg. Today, many podiatrists specialize in diabetes foot care. If you have a foot injury, ulcer, or other abnormalities such as bunions and calluses a podiatrist can prescribe accomodative orthotics or custom made diabetes shoes. If you have a bunion, for example, getting a pair of extra wide or deep shoes to aid in comfort and safety. As preventive services, a podiatrist can trim your nails and scale your feet.