Download Cobb-Diabetic Foot Care

2/6/2017
Diabetic Foot Care
Comprehensive Management of the Diabetic Foot
Chris Cobb, PT
Clinic Manager
CoxHealth Center for Prosthetics & Orthotics
Geriatric Diabetes and the Foot
• 1995 to 2004, Type 2 prevalence increased in Nursing Home residents
from 16 to 23%
• In elderly, higher risk of polypharmacy, functional disabilities,
cognitive impairment, depression and persistent pain.
• Risk for foot problems is higher in elderly
• Estimated 32% of people with DM have neuropathy, but more than
50% in those over 60
• More than 30% of older DM patients cannot see or reach their feet
for routine foot inspections
Geriatric Diabetes and the Foot
• Elderly should have their feet inspected at every visit and assessed for
their ability to perform a self exam
• DM is associated with increased risk of dementia- difficulty
performing self management and following treatment regimens
• Cognitive function should be assessed during any therapy evaluation
and when there is non-adherence with treatment, frequent episodes
of hypoglycemia or deteriorating control of glycemic levels.
1
2/6/2017
Geriatric Diabetes and the Foot
• Annual cost of DM was 245 billion in 2012- ADA
• 6% of DM annually have foot ulcer, 25% of DM over lifetime
• Major cost to treat, hospitalization, and linked to high mortality rate
• In elderly, this rate is increased due to frequent other co-morbidities
• Foot problems cause approx. 20% of diabetic hospitalizations
• DM foot- up to 25% risk for foot ulcer in lifetime
• Risk factors-previous foot ulceration, neuropathy, deformity, vascular disease
• Neuropathy present in over 80% of patients with ulcer
Observations from the Clinic
What do we see in the clinic?
• Decreased awareness of neuropathy
• Improper shoe selection
• Poor fitting shoes
• Lack of patient education regarding foot care
LEAPLEAP- Lower Extremity Amputation Prevention
Developed to reduce LE amputations, developed at HRSA in 1992 (Health Resources and Services Administration)
US Dept. of Health and Human Services
Program consisting of five components:
• Annual foot screening
• Patient education
• Daily self inspection
• Management of simple foot problems
• Footwear selection
• Physical Therapists and Certified Pedorthists at CoxHealth are LEAP trained
2
2/6/2017
LEAP- Foot Screening
• Identifies loss of protective sensation
• Monofilament 5.07, 10g
• Patients who are at risk should be seen more frequently, up to 4x/yr
• Rates as 0-3 risk category
• Documents status of foot including ROM, deformities, skin status,
pulses, patient’s ability to self monitor
LEAP- Patient Education
• Teaches patient the self management skills needed to assume
personal responsibility for their foot health
• Verbal and written education include daily foot care, daily self
inspection, socks and shoes, foot care warnings and resources
LEAP- Daily Self-Inspection
• Vital component of self-management
• Should be done daily with LOPS (loss of protective sensation)
• Early detection of foot injuries helps prevent more serious problems
• Some can be self managed while others need reported to health care
provider
3
2/6/2017
LEAP- Management of Simple Foot Problems
• Neuropathy can affect autonomic nervous system and lead to dry,
cracked skin and increased risk for injury and wounds
• Patients must be vigilant in managing the health of their skin daily
• Proper nail care-might require Podiatrist or nail care professional
• Skin moisturizers
LEAP- Footwear Selection
• With protective sensation people can wear any style of shoe with little
risk for injury. Our sensation lets us know if we are having pain or
creating skin irritation of any kind.
• Without protective sensation, an improper fitting shoe/insert can
cause serious complications.
• LOPS- never go barefoot, avoid narrow toe shoes, heeled shoes, vinyl
uppers, flip-flops, or any shoe that is too loose or too tight
• Shoe should be the shape of the foot, ½” between longest toe and end
of shoe
Diabetic Footwear
My Doctor ordered Diabetic Shoes, how do I get them?
• Medicare and most insurances cover shoes and inserts for diabetic patients IF they qualify
• Diagnosis of DM by itself is not enough
• Diabetic shoes/inserts provide a safe, well fitting shoe that can accommodate a cushioned multilayer insert. This is all to decrease the risk of any skin breakdown.
• Medicare Policy is complicated and not easy to follow for most patients
• If patient qualifies, allows one pair of shoes and up to 3 pair of inserts per calendar year
4
2/6/2017
Diabetic Footwear
Medicare Policy- LCD L33369 “Therapeutic Shoes for Persons with Diabetes”
https://med.noridianmedicare.com/documents/2230703/7218263/Therapeutic+Shoes+for+Persons+with+Diabetes/e20fbc7e-6960-458b8156-796e24e17152
• Must have face-to-face with MD/DO that is managing diabetes in last 6 months that documents
comprehensive management of persons diabetes
• Must sign a Certified Statement- usually provided by the supplier
• Must document one of the following qualifying conditions in detail:
•
•
•
•
•
•
Previous amputation of the other foot, part of either foot, or
History of previous foot ulceration of either foot, or
History of pre-ulcerative calluses or either foot, or
Peripheral neuropathy with evidence of callus formation of either foot, or
Foot deformity of either foot, or
Poor circulation
Diabetic Footwear
Obtaining your Diabetic Shoes/Inserts @ CoxHealth
Schedule evaluation with Certified Pedorthist once all documentation complete
•
•
•
•
Comprehensive foot evaluation
Size for shoes and pick style
Take impression of feet to make custom inserts/orthotics
Harris Mat pressure mapping
Follow up for delivery of shoes/inserts when ready, typically 3-4 weeks.
CoxHealth Center for Prosthetics & Orthotics 417-730-2000
5