Review Article
Year: 2019 | Month: September | Volume: 9 | Issue: 9 | Pages: 219-223
Physiatrist’s Assessment and Management of Diabetic Foot
Dr. V. Ramamoorthy
Professor and Head, Department of Physical Medicine and Rehabilitation, PSG Institute of Medical Sciences & Research, Coimbatore, Tamilnadu.ABSTRACT
The incidence of diabetes is increasing day by day in India. By the year 2030, India will be the world capital of diabetes. Foot ulcerations, infections and Charcot neuropathic osteoarthropathy are three serious foot complications of diabetes mellitus that can too frequently lead to gangrene and lower limb amputation. Although not all foot complications can be prevented, dramatic reductions in their frequency have been achieved through the implementation of team approach to diabetic patient management. A multidisciplinary team approach is recommended for individuals with diabetic foot ulcers. Foot ulcers and wound care may require care by a podiatrist, orthopedic surgeon, vascular surgeon and physiatrist experienced in the management of individuals with diabetes. A Physiatrist is a medical doctor who specializes in physical medicine and rehabilitation. Physiatrists diagnose and treat both acute and chronic pain, and specialize in a variety of nonsurgical treatment for the musculoskeletal system. Initial screening for peripheral arterial disease (PAD) should include a history of claudication and an assessment of pedal pulse. Ankle brachial index (ABI) to be obtained in as many patients with PAD being asymptomatic. The neurologic examination recommended is designed to identify loss of protective sensation by simple clinical tests like use of a 10 G monofilament, tests of pinprick sensation, ankle reflex assessment, vibration testing using a 128HZ tuning fork and testing vibration perception threshold with a Biothesiometer. Patients with diabetes and high risk foot conditions should be educated about proper care of the foot and the selection of appropriate footwear. Plantar pressure is measured using podia scan and areas of high plantar pressure are identified. Footwear which offers pressure relief over these high plantar pressure areas is then prescribed. Interim footwear to be used by the patients who have forefoot and hind foot ulcers which require off loading the ulcer areas till the ulcer is healed.
Key words: Ankle brachial Index, Biothesiometry, Podia scan, Ideal diabetic footwear