History
Diabetics present to the foot and ankle surgeon in a number of scenarios:
- with any foot and ankle problem and diabetes as an incidental part of the past medical history - important to assess how much diabetes increases the risk of any proposed surgical or non-surgical treatment
- with an acutely "hot foot" where the main differential diagnosis is between infection and Charcot arthropathy
- with an ulcer which may or may not be complicated by deep infection or ischaemia
- with a deformity which has led to recurrent ulceration, or is felt to be a risk factor for ulceration - important to assess the relative risks of corrective surgery and continuing protective care
Whatever the initial presentation, it is important to ask about:
- what type of diabetes does the patient have (type 1 or type 2)
- how is it managed - diet, oral hypoglycaemics, insulin - and what agents and regime
- who normally looks after the patient's diabetes - GP/practice nurse/hospital diabetic clinic and therefore who is likely to have the patient's diabetic records
- how well controlled is the diabetes - review the patient's glucose monitoring record and ask when the last HbA1c test was done and what was the result and the previous trend
- does the patient have any of the major complications of diabetes
- cardiovascular disease
- renal disease
- eye disease
- has the patient had an ulcer or Charcot arthropathy before - the single biggest risk factor for either of these conditions is to have had them before
Also, of course, ask the usual questions about any foot and ankle condition - any history of:
- arthritis
- trauma
- neurological conditions or spinal problems
- family history or previous personal history of the same problem