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!!!!