Diabetes and Your Diabetes and Your FeetFeet

A Brief Overview

Dr. John Kadukammakal, DPM, Dr. John Kadukammakal, DPM, AACFASAACFAS

BackgroundBackgroundBorn & raised in Philadelphia, PA.Medical School @ Temple

University3 year surgical training at Crozer

Keystone Health System in Chester, PA.

Office Location:◦Richmond Medical Park

2008 Bremo Road Suite 100, Richmond, VA. 23226

804-285-3933

Diabetes Statistics Diabetes Statistics (2011)(2011)

Nearly 25.8 million people, or 8.3 % of the U.S. population, have diabetes

18.8 million people have been diagnosed

7 million people are still undiagnosed

Categories of DiabetesCategories of Diabetes

Type 1 (Insulin Dependent)

Type 2Non-insulin DependentDiet Controlled

Pre-Diabetic ???

Diabetes – A Systemic Diabetes – A Systemic IssueIssue

Not only affects your blood sugar Not only affects your blood sugar levellevel

Affects major organsAffects major organs◦BrainBrain◦HeartHeart◦KidneysKidneys◦EyesEyes◦Feet!!!!!Feet!!!!!

Diabetes & the FeetDiabetes & the Feet Diabetes can cause :

Delayed Healing Lower Extremity Edema (Swelling)

Also seen with HTN, Kidney Issues, Venous Insufficiency

PVD (Peripheral Vascular Disease) Wounds/Ulcers Charcot Deformity

Prevalence of UlcersPrevalence of UlcersUp to 25 % of those with

diabetes will experience an ulcer or wound at some point.

Amputation rates can be reduced by 45 to 85 % with a comprehensive foot care program.

Without proper treatment, ulcers can quickly escalate into amputation.

Diabetic Foot Diabetic Foot WoundsWounds

Diabetic Foot Diabetic Foot WoundsWounds

Charcot FootCharcot Foot

Charcot FootCharcot Foot

Diabetic NeuropathyDiabetic Neuropathy

Disease of the nerves in legs and feet Cause nerves to misfire &

miscommunicate Can result in burning, tingling, “electric

shocks,” “bee-stings” Can happen if blood sugar is high or

normal Can be treated with good sugar control

and medication if needed

What is a Podiatrist?What is a Podiatrist? A specialist trained to treat and

manage disorders of the foot and ankle.

Job of a PodiatristJob of a Podiatrist Perform thorough Foot ExaminationsPerform thorough Foot Examinations

Check circulation, sensation, etc.Check circulation, sensation, etc.Trim toenails, corns, callusesTrim toenails, corns, callusesCorrect foot/ankle deformities either Correct foot/ankle deformities either

surgically or conservativelysurgically or conservativelyHammertoes, Bunions, Flat feet, etc.Hammertoes, Bunions, Flat feet, etc.

Manage NeuropathyManage Neuropathy

For any foot/ankle problemsFor any foot/ankle problemsIf Diabetic & controlledIf Diabetic & controlled

◦At least twice a yearAt least twice a yearIf Uncontrolled DiabeticIf Uncontrolled Diabetic

◦Every 3 monthsEvery 3 months

When to see a When to see a Podiatrist?Podiatrist?

PedicuresPedicuresAre they wrong?Are they wrong?What should I get done?What should I get done?What to look out for?What to look out for?

Shoe gearShoe gearWhat kind is the best?What kind is the best?

◦Depends on the level/type of Depends on the level/type of activityactivity

What to look for in a shoe?What to look for in a shoe?Are flip-flops bad?Are flip-flops bad?

Diabetic ShoesDiabetic ShoesShoes that are wider and deeper Shoes that are wider and deeper

than regular shoesthan regular shoesInserts are made from mold of Inserts are made from mold of

your feetyour feetCome in a wide variety of stylesCome in a wide variety of stylesOne pair per calendar year is One pair per calendar year is

covered by Medicare…and some covered by Medicare…and some private insurancesprivate insurances

Diabetic ShoesDiabetic Shoes

How To Manage Your FeetHow To Manage Your FeetPerform Daily Foot InspectionsPerform Daily Foot InspectionsMoisturize twice a day (except in Moisturize twice a day (except in

between your toes)between your toes)◦Coco Butter, Nivea Cream, Eucerin Coco Butter, Nivea Cream, Eucerin

Cream, LubridermCream, LubridermDo not walk barefoot!!!Do not walk barefoot!!!No bathroom surgery!!!!No bathroom surgery!!!!Socks (white cotton)Socks (white cotton)Inspect Shoes…& rotate themInspect Shoes…& rotate themCOMMON SENSE!!!!COMMON SENSE!!!!