Diabetic Foot Assessment
By Dr. Suzanne Belyea, D.P.M., C. Ped.

Because diabetes disrupts the vascular system, it affects many areas of the body including the feet. For this reason, diabetics have to pay special attention to the health and care of their feet, with regular visits to their physicians for neurological, vascular and skin assessments.
Diabetic foot conditions develop from a combination of causes, including poor circulation and neuropathy. Diabetic Neuropathy can cause insensitivity or a loss of ability to feel pain, heat and cold. If you are suffering from neuropathy, you may not be aware of minor cuts, scrapes, blisters or pressure sores that develop on your feet. If these minor injuries are left untreated, complications may result and lead to ulceration and possibly even amputation. Neuropathy can also cause deformities such as bunions, hammer toes, and charcot feet.
It is critical, therefore for diabetics and their physicians to assess the condition of the feet on a regular basis, and take the necessary precautions to prevent all foot related injuries.

Neurological assessment

Do you have symptoms of burning or tingling? If so, you should contact your doctor immediately and request a simple neurological assessment that can determine the extent of nerve damage in your feet. This assessment includes tests to determine pressure perception, vibratory sensation, your ability to discriminate between sharp and dull pressure, tactile sensation and the Achilles tendon reflex. If your physician determines that there is a problem, he or she will discuss treatment options with you.

Vascular Assessment

Your physician should also perform a vascular assessment of your feet. He or she will check for claudication (calf pain), sometimes measured by the number of blocks you can walk before having calf pain. Rest pain is also important when determining vascular health or impairment, as well as such factors as pedal pulses, skin discoloration, a lack of color when the foot is elevated, or the presence or absence of digital hair (presence is a positive sign).

Skin Assesment

Examining the skin can also offer important clues to diabetic foot health. Red, hot skin is a sign of infection, and requires immediate assessment by a physician.
If the skin is red but not hot, the redness might be caused by the rubbing of a shoe that could cause the skin to break down if it continues. Corns or Calluses may also be a sign of pressure from a shoe or from walking barefoot.
Edema (swelling) in the foot can be caused by various disorders that interfere with the water balance in the body. For example, heart failure, renal failure, alcoholism, vitamin deficiency and various medications can cause edema. If edema is discovered in the feet, the goal is to treat the underlying cause.
Your toenails should be evaluated for infection (onychomycosis), which causes thick, yellow nails that are difficult to cut. Ingrown toenails (onychocryptosis) can cause an infection of the nail border (paronychia). If nail pathology is present, you should see a podiatrist to have them cut professionally.
Gangrenous skin requires the urgent attention of a physician.

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Dr. Suzanne Belyea, medical director of Foot.com and Apex Foot Health Industries, is a podiatric physician who specializes in conservative treatment modalities for common foot problems. She regularly leads seminars and workshops on footcare for diverse gatherings of heathcare professionals, including orthotists, prosthetists, physical therapists, pedorthists and many others. Dr. Belyea is one of a select group of podiatrists who are also board certified in pedorthics. A graduate of Pennsylvania College of Podiatric Medicine, Dr. Belyea serves on the advisory board of Apex Foot Health Industries, Inc. For more information, visit www.foot.com.