Office-based screening, prevention, and management of diabetic foot disorders

Diabetic foot problems are significant cause of morbidity. With good medical care, the progression of neuropathy and vascular disease can be slowed but not stopped. Effective diabetic foot care requires screening to detect the at-risk foot, prevention to avoid the occurrence of ulcers, and treatment to heal ulcers quickly before they become more significant problems. Screening comprises assessment of patient behaviors and skin, neurologic, and vascular examinations. Prevention is accomplished by patient education and appropriate footwear or bracing. Recognition of Charcot's arthropathy can greatly reduce the risk of later problems. If problems progress beyond the scope of basic treatment by the primary care physician, referral to other members of the diabetic team is indicated.