What is the best management approach for a 48-year-old diabetic male patient presenting with tingling and numbness in both shins, multiple scars over both tibias, and calluses on the right foot?

Management of Diabetic Foot Complications in a 48-Year-Old Male

The comprehensive management approach for this diabetic patient with tingling, numbness, multiple scars, and calluses should include therapeutic footwear (such as the Apex X521M), regular foot care with Epsom salt baths and pumice stone, emollient application, and regular monitoring with monofilament testing to prevent foot ulceration and its serious complications. 1

Risk Assessment and Classification

This 48-year-old male patient presents with:

• Tingling and numbness in both shins
• Multiple scars over both tibias
• Calluses on the right foot
• Diabetes (risk factor for foot complications)

These findings suggest diabetic peripheral neuropathy with loss of protective sensation, placing him at moderate to high risk for foot ulceration (IWGDF risk 2-3).

Management Plan

1. Therapeutic Footwear

• The prescribed Apex X521M medical shoes in size 9.0 is appropriate for this patient 1
• Therapeutic footwear is strongly recommended for patients with diabetes who have foot deformities or pre-ulcerative lesions 1
• The patient should be instructed to wear these shoes consistently both indoors and outdoors 1
• Proper fit is essential: shoes should be 1-2 cm longer than the foot, with width equal to the widest part of the foot 1

2. Foot Care Regimen

• Callus Management:

  • Regular use of pumice stone to gently remove calluses 1
  • Epsom salt foot baths to soften calluses before removal 1

• Skin Care:

  • Daily application of Lubriderm cream as prescribed to moisturize dry skin 1
  • Instruct patient to wash feet daily with careful drying, particularly between toes 1

3. Patient Education

• Teach patient to inspect feet daily for new lesions, discoloration, or injuries 1
• Instruct never to walk barefoot, in socks only, or in thin-soled slippers 1
• Explain the importance of consistent wearing of prescribed footwear 2
• Educate about proper nail care (cutting straight across) 1

4. Regular Monitoring

• Monofilament testing as prescribed to assess for loss of protective sensation 1
• Schedule follow-up appointments every 1-3 months given the high-risk status 1
• Monitor for temperature differences between feet, which may indicate inflammation 1

Importance of Adherence

Research shows that therapeutic footwear reduces ulcer recurrence by 46% when worn as recommended 2. However, compliance is often low, with studies showing only 22% of patients regularly wear their prescribed footwear 3. It's crucial to emphasize to the patient that:

• Most ulcerations occur indoors where patients often don't wear their therapeutic shoes 2
• The prescribed Apex shoes should be worn both inside and outside the home 1
• Consistent use of appropriate footwear significantly reduces morbidity and mortality associated with diabetic foot complications

Integrated Care Approach

Provide integrated foot care that includes:

• Professional foot treatment (callus removal, nail care)
• Appropriate footwear (Apex X521M)
• Structured education about self-care
• Regular follow-up every 1-3 months 1

This comprehensive approach is essential to prevent foot ulceration, which carries significant risks of infection, amputation, reduced quality of life, and increased mortality in patients with diabetes 1.