Which Medical Specialty Should You Consult for Diabetic Foot Issues?

Which department should be consulted for a diabetic foot examination?

Hello Doctor: Diabetes can lead to foot complications, and which department should one consult for a foot examination? Should it be the Department of Metabolism, Internal Medicine, Surgery, Neurosurgery, Dermatology, or Oncology? I would greatly appreciate your response.
Thank you! Additional information: My mother has been diagnosed with diabetes for ten years (she takes her medication as prescribed daily, and her doctor says her blood sugar is stable).
She has two hard lumps on the sole of her left foot, but there are no wounds, and they are not painful.
Online resources suggest that a pulse and neurological examination should be conducted approximately every three months; however, this has not been done yet, so we cannot determine if there are any foot complications.
Additionally, my mother had endometrial cancer four years ago, which has been surgically removed, but we are unsure if it has metastasized to her foot.
In this situation, which department should we consult? Mary

mary, 40~49 year old female. Ask Date: 2006/08/23

Dr. Shi Guangzhong reply Internal Medicine

1.
Regarding which department to consult for foot examinations: Foot lesions can be identified through some simple assessments.
Medical institutions within the diabetes care network typically include foot examinations as part of their services.
The assessment of small nerve function can be conducted using the monofilament test and the semi-quantitative tuning fork test.
To evaluate vascular-related foot lesions, the ratio of blood pressure measurements between the upper arm and lower limbs can indicate the presence of foot vascular obstruction.
If the foot lesions are due to nerve function impairment, further follow-up and treatment can be done by a neurologist.
For foot lesions caused by vascular obstruction, further follow-up and treatment can be provided by a vascular surgeon.
2.
Your mother has two hard spots on the soles of her feet but no open wounds.
If these hard spots are corns or calluses, it is recommended that your mother change to a good pair of shoes, such as cushioned shoes with a thick, rounded toe, to avoid increasing friction on the soles.
The hard spots can be gently filed with a pumice stone during bathing to reduce callus formation.
If the hard spots show signs of pathology or if they become excessively thick, it is advisable for your mother to visit a plastic surgery outpatient clinic for evaluation and treatment.
The physician can also determine if a biopsy is necessary to rule out the possibility of cancer cell metastasis, although it is rare for cancer cells to metastasize to the feet.
For patients with vascular obstruction, the Ankle-Brachial Index (ABI) test is currently recommended every three years for stable patients (without vascular obstruction) and annually for those with vascular obstruction.
For cancer patients, surviving five years is considered a sign of being cured.
Congratulations, your mother is on her way to recovery.

Reply Date: 2006/08/23

More Info

When dealing with diabetic foot issues, it's essential to consult the right medical specialty to ensure comprehensive care. Given the complexities associated with diabetes, particularly its complications affecting the feet, several specialties may be involved in the diagnosis and treatment of diabetic foot problems.

1. Endocrinology: This specialty focuses on diabetes management, including blood sugar control, which is crucial for preventing complications like diabetic foot ulcers. An endocrinologist can help optimize your mother's diabetes management, which is foundational for preventing further foot issues.

2. Podiatry: A podiatrist specializes in foot and ankle care and is particularly knowledgeable about diabetic foot problems. They can perform foot examinations, assess circulation and nerve function, and provide treatment for any foot-related issues, including calluses, ulcers, or infections. Given that your mother has hard lumps on her foot, a podiatrist would be well-suited to evaluate these and recommend appropriate footwear or treatment options.

3. Vascular Surgery: If there are concerns about blood flow to the feet, a vascular surgeon can assess and treat any peripheral vascular disease that may be contributing to foot problems. They can perform tests like the Ankle-Brachial Index (ABI) to evaluate blood circulation.

4. Neurology: If there are signs of neuropathy (nerve damage), a neurologist can conduct tests to assess nerve function. Neuropathy is a common complication of diabetes and can lead to loss of sensation in the feet, increasing the risk of injuries and ulcers.

5. Dermatology: If there are skin issues, such as infections or unusual growths, a dermatologist can provide specialized care. They can help with skin-related complications that may arise from diabetes.

6. Oncology: Given your mother's history of endometrial cancer, if there are concerns about the hard lumps on her foot potentially being cancerous or metastatic, an oncologist should be consulted. They can perform necessary evaluations to determine if there is any cause for concern regarding cancer recurrence.

In summary, for your mother's diabetic foot issues, starting with a podiatrist would be advisable, as they can provide a thorough examination and address most foot-related concerns. If necessary, they can refer her to other specialists, such as an endocrinologist for diabetes management, a vascular surgeon for circulation issues, or an oncologist if there are concerns about the lumps on her foot.

Additionally, regular foot care is crucial for diabetic patients. This includes daily inspections of the feet for any cuts, blisters, or changes in color, wearing appropriate footwear, and maintaining good blood sugar control. Your mother should also have regular check-ups with her healthcare provider to monitor her diabetes and any potential complications.

Overall, addressing diabetic foot issues requires a multidisciplinary approach, and consulting the right specialists can significantly improve outcomes and prevent serious complications such as infections or amputations.

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