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Age > 40 Smoking Poor glycemic control Diabetes duration > 10 years Anatomical changes (bunions, hammertoes, prominent metatarsal heads History of prior foot ulcers amputation
Neuropathy Component
Symptoms
painful dysesthesias decreased sweating motor weakness decreased sensation of touch, vibration diminished pulses muscle atrophy with change in foot shape
Signs
Musculoskeletal Component
Symptoms
Signs
cavus feet with claw toes rocker bottom foot prominent metatarsal heads arthropathy of the ankle joint
Dermopathy Component
Symptoms
scaling, itching, dryness slow wound healing trophic changes of skin and nails fungal infections ingrown nails with paronychia subungual ulceration or abscess
Signs
Vascular Component
Symptoms
Signs
Prevention
Teach preventive footcare Instruct patient to seek healthcare immediately for foot lesions, infection
Preventive Footcare
Inspect and wash feet daily Wear shoes and socks at all times
inspect and shake out shoes before wearing be extra careful with new shoes socks for cold weather do not put foot near heat (stoves, fires,
heating pads etc) test bath water with elbow (not hand or foot)
Preventive Footcare
do not cut off excess skin do not use chemical callus treatments soak feet only enough to soften callus for
treatment use pumice stone or nail file to remove excess skin apply lotion/oil daily
Preventive Footcare
Nail Care
cutting Cut straight across to avoid ingrown nails Leave nails 1/4 to 1/2 inch long (0.5 cm)
Skin Care
Ulcer Care
Bed rest/non-weight bearing essential Dry debridement with gauze patch 4 times daily Do not soak ulcers (breaks down protective barrier) Antibiotics for infection - parenteral may be required May be down to bone with no symptoms
Amputations due to the diabetic foot syndrome can be prevented in 5070% of cases if these preventive measures are followed.