Diabetes and Peripheral Vascular Disease Management

Patient Monitoring and Prevention

Daily foot inspection is recommended for patients with diabetes or peripheral vascular disease to reduce the risk of complications, including checking between the toes and inspecting the inside of shoes for rough edges or uneven seams, as advised by the American Diabetes Association 1, 2, 3
Proper foot care is essential for preventing complications, particularly in diabetic patients, and includes wearing properly fitting shoes with adequate width and a rounded toe box, as recommended by the American Diabetes Association and the Diabetes/Metabolism Research and Reviews 1, 2
Patients should avoid walking barefoot, in socks without footwear, or in thin-soled slippers, whether at home or outside, to prevent callus formation and other complications, as advised by the American Diabetes Association 1, 2
Regular monitoring and assessment for loss of protective sensation using monofilament testing is recommended for diabetic patients, with consideration of referral to foot care specialists for ongoing preventive care, as recommended by the American Diabetes Association 3
Daily inspection of feet for any pre-ulcerative signs, such as erythema, warmth, or signs of skin breakdown, is crucial for early detection and prevention of complications, as recommended by the Diabetes/Metabolism Research and Reviews and the American Diabetes Association 4, 5, 6

Evaluate calluses for location, appearance, pain level, signs of inflammation, presence of cracks or fissures, and any underlying blisters, according to the British Journal of Dermatology guidelines 7
Callus management involves professional debridement by a podiatrist using a scalpel or blade as the recommended first-line treatment, followed by pressure redistribution through appropriate footwear and cushioning to prevent recurrence, as recommended by the British Journal of Dermatology guidelines 7
Refer to a podiatrist for manual debridement, which provides immediate relief by removing thickened tissue, but caution against overdebridement which can increase tenderness, as stated in the British Journal of Dermatology guidelines 7
Apply emollients and non-adherent dressings to protect the debrided skin, and use urea-based creams to help keep the skin soft and prevent recurrence, as recommended by the British Journal of Dermatology guidelines 7

A treatment plan including gel insoles, Epsom salt foot baths, and gentle debridement with a pumice stone is appropriate for non-diabetic patients without circulatory problems, but for diabetic patients or those with circulatory issues, a more cautious approach with professional debridement and more frequent monitoring is necessary, as stated by the Diabetes Care journal 8
Schedule follow-up in 1-3 weeks to assess treatment response, and regular maintenance debridement may be necessary, as stated in the British Journal of Dermatology guidelines 7
Educate patients about proper footwear selection, regular foot inspection, and continued use of orthotics and proper footwear to prevent recurrence, as suggested by the American Podiatric Medical Association guidelines

Purulent discharge or spreading redness suggesting infection, severe pain unresponsive to initial treatment, signs of systemic illness, or discoloration suggesting deep tissue infection or necrosis require immediate medical attention, as recommended by the Clinical Infectious Diseases guidelines 9
Infection risk is a concern with any invasive procedure, particularly important in diabetic or immunocompromised patients, according to the Infectious Diseases Society of America 10
More aggressive monitoring and treatment is warranted due to risk of complications, such as infection, particularly important in diabetic or immunocompromised patients, as stated by the American Diabetes Association 1, 11

Document the specific deformity characteristics, associated findings, and functional impact of foot conditions to guide appropriate management and prevent complications, particularly in patients with diabetes 5
Assessing for erythema, warmth, or signs of skin breakdown is crucial, as these can be pre-ulcerative signs, and documenting any open wounds, ulcerations, or fissures is essential for guiding treatment and preventing further complications 5, 6
The results of 10-g monofilament testing should be documented to assess sensory function and identify patients at risk of losing protective sensation (LOPS), and documenting pedal pulses (dorsalis pedis and posterior tibial) is essential for assessing vascular status and identifying patients at risk of peripheral arterial disease 5, 8, 3