13740 Pocket Folder Brochure_Layout 1 2/10/11 11:17 AM Page 4. Your. Comprehensive Diabetic Foot Exam. Your first step toward healthy living

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1 13740 Pocket Folder Brochure_Layout 1 2/10/11 11:17 AM Page 4 Your Comprehensive Diabetic Foot Exam Your first step toward healthy living

2 13740 Pocket Folder Brochure_Layout 1 2/10/11 11:19 AM Page 6 Are you at risk of developing a diabetic foot ulcer? Let us help you find out. People with diabetes can develop many different foot problems. Even ordinary problems can get worse and lead to serious complications. Each year, more than 90,000 people with diabetes have amputations, but research now suggests that more than 85% of these amputations can be prevented with proper foot care. The Comprehensive Diabetic Foot Exam (CDFE), conducted by your podiatrist, provides identification of key risk factors that can lead to diabetic complications of your feet. A portion of the CDFE includes informative education on your specific risk factors and proper foot care to maintain healthy feet. Foot problems often happen when there is nerve damage (neuropathy), which results in loss of feeling in your feet. This loss of the gift of pain, when combined with foot deformities and high-pressure points, makes it more likely that you will develop a non-healing wound. Because you may not be able to feel a wound develop, by the time you can actually see the wound, it is often too late, possibly resulting in amputation. Depending on the results of your CDFE and personal "60-Second Foot Exam," your podiatrist will have determined whether you could benefit from therapeutic shoes and inserts which are often covered, in part, by Medicare. Other preventive care devices that can help you protect your feet and assist in the daily examination of them for signs of inflammation and other pending dangers may also be recommended to you during your visit.

3 13740 Pocket Folder Brochure_Layout 1 2/10/11 11:20 AM Page 9 What is the Comprehensive Diabetic Foot Exam (CDFE)? Monitoring diabetes to prevent amputations T he CDFE is a physical examination combined with an educational and counseling session performed by podiatrists on people with diabetes. During this exam, your podiatrist will conduct some simple, non-invasive tests on your feet, including: Testing your feet to determine if you have lost any feeling in your feet, have any circulatory problems or have any noticeable damage; Checking your feet for signs of abnormal pressure points and foot deformity; Taking a thermal image of your feet to identify any areas of inflammation; Evaluating the condition of your skin, which tends to get dry and brittle in people with diabetes. The CDFE is concluded with an educational session to inform you about your personal risk factors and counseling on proper foot care. On completion and review of your CDFE, preventative measures will be recommended to alleviate the presence of health-threatening pressure points and the development of life-threatening foot ulcers. Your podiatrist may prescribe therapeutic footwear and inserts and determine whether you qualify for coverage under Medicare s Therapeutic Shoe Program. Comprehensive Diabetic Foot Exam (CDFE) is designed to create foot health awareness, for people with diabetes, through education and examination by trained staff. PressureStat

4 13740 Pocket Folder Brochure_Layout 1 2/10/11 11:21 AM Page 10 Your feet are under pressure Inflammation starts with hot spots PressureStat identifies specific areas of concern Use TempStat for daily detection of inflammation As part of your CDFE, PressureStat a unique, non-invasive device will be used to capture your footprint. The PressureStat prints indicate any abnormal or unusual pressure points. TempStat is part of the CDFE that your podiatrist will use to evaluate the temperatures on the bottom of your feet. And when at home, daily monitoring of your feet is simplified with TempStat assisting with both the visible and invisible signs of wounds and infections. Your footprint will appear in tones of gray to black. The darker areas are points of concern that indicate areas of high pressure on the soles of your feet. These pressure points are the areas that are at risk of developing into ulcers, which, left unattended, can result in serious complications even amputation. Simply put: DARK IS DANGEROUS. You can t treat what you can t see or feel The CDFE with PressureStat is designed to help you and your podiatrist see areas of concern, then take appropriate corrective action before problems develop. This may include the prescription of therapeutic shoes and/or inserts. The therapeutic shoes and/or inserts will help offload the areas of high pressure and redistribute them over a greater surface area, relieving the potential development of health threatening ulcers or future complications. Your podiatrist showed you possible areas of concern on the prints. You will be able to take your PressureStat footprints home with you. Refer to your copy of the PressureStat prints to know which areas to monitor when checking your feet at home. How often do you look at the soles of your feet? The American Diabetes Association recommends that you examine your feet every day for signs of irritation and damage. If you have neuropathy (nerve damage and loss of feeling), or are simply unable to see the bottoms of your feet, you might be unaware of developing sores as you have lost the gift of pain that neuropathy takes away. We know that inspecting the bottom of your feet is very difficult. Monitoring you feet for signs of inflammation or infection, which are invisible, is even more difficult. Your podiatrist can prescribe a TempStat device to help you examine your feet daily at home. TempStat is the only device approved by the FDA to detect signs of inflammation of the soles of the feet. This device is easy to use and creates vivid, color contrasts to identify "hot spots" areas of increased temperature where inflammation and possible infection are present. Check your feet daily: After placing your feet on the thermal pads, areas of concern you couldn t see or feel, due to neuropathy (loss of feeling) or your inability to view the soles of your feet, become evident and your podiatrist should be notified. If one footprint is not like the other, inflammation may be present. You can also examine the bottom of your feet with the center-console magnification mirror. Please refer to your PressureStat prints to compare the dark, high pressure "areas of concern" on the prints against any "hot spots"that may appear on your TempStat device should your physician prescribe one. Get in the habit. Check your feet daily. Areas of concern TempStat

5 13740 Pocket Folder Brochure_Layout 1 2/10/11 11:21 AM Page 11 What is the MedicareTherapeutic Shoe Program? Some people with diabetes need therapeutic footwear R ecognizing that foot complications can seriously affect the health and well being of patients with diabetes, Medicare has established a program to help people with diabetes who are at risk of developing foot ulcerations. For those who qualify, Medicare will pay 80% of the allowed amount for one pair of shoes and up to three pairs of inserts per year. Most secondary insurers will help with the remaining 20%. How do I know if I qualify for shoes under the Medicare Therapeutic Shoe Program? Not all patients with diabetes will qualify for or need therapeutic footwear and inserts. To qualify you must be under a comprehensive diabetes treatment plan managed by your physician and have one or more of the following: Partial or complete amputation of the foot Previous foot ulceration History of pre-ulcerative callus Peripheral neuropathy with evidence of callus formation Foot deformity Poor circulation

6 13740 Pocket Folder Brochure_Layout 1 2/10/11 11:21 AM Page 12 Who prescribes the therapeutic shoes and inserts? In order to qualify for the program, certain criteria must be met. Your podiatrist will provide the required prescription for shoes if he/she finds them necessary to prevent foot complications. Your podiatrist will have measured your feet, suggested off-loading inserts and fitted shoes to your size. You will also have selected a shoe style at the time of your exam. The prescription and all certifying paperwork, along with notations regarding your shoe selection will be forwarded from the podiatrist s office for processing prior to being sent to Medicare for approval. When will I receive my therapeutic shoes and inserts? Upon approval of all paperwork (1 3 weeks) you will be notified to return to your podiatrist s office for a final fitting and to pick up your shoes. At that time you will be asked to sign a receipt indicating that you received the shoes and inserts. This receipt will be placed in your medical file. How often should I wear my therapeutic shoes and inserts? If it is determined that you need therapeutic shoes and/or inserts, it is important to wear them everyday to off load high pressure areas, which help prevent calluses from forming that can lead to sores, ulcerations and potentially amputation. Your therapeutic shoes are a critical line of defense every time you walk.

7 13740 Pocket Folder Brochure_Layout 1 2/10/11 11:21 AM Page 13 The Comprehensive Diabetic Foot Exam (CDFE) Frequently Asked Questions Q: Why are people with diabetes at risk of amputation? A: You may not be able to monitor your feet yourself or the numbness of neuropathy may prevent you from feeling if your skin is cracking, calluses have formed, or foot ulcers have developed all leading to the need for amputation if left untreated. Q: What are the early-warning signs of risk? Are my feet at risk? A: The sense of pain, which neuropathy takes away, is an early sign that protects us from further harm. People with diabetes often lose feeling with the advancement of neuropathy (nerve damage). In such cases people do not experience the warning sign of pain when they should. You might not recognize the early risk sign of a callus, which eventually may become a blister and later break the skin s surface. This becomes an open doorway for infection, ulceration and eventually the common need for amputation if no corrective measures are taken early enough. Q: How does the temperature of the feet change with the onset of an ulcer? A: Inflammation beneath the skin causes the surface temperature to rise higher than that of non-infected areas. On the TempStat device, the increased temperature is indicated by a distinct area that is different in color from the footprint of the same foot or the other foot. Q: Are all people with diabetes at risk for foot ulcers? A: All people with diabetes may be at risk for foot ulceration, but not all people with diabetes are at the same risk. Depending upon how well they monitor and control their diabetes. Some people may suffer fewer problems than others. Current U.S. statistics indicate that 40-50% of all people with diabetes will suffer some kind of foot problem that leads to an ulceration and possible loss of toe or foot in their lifetime. If you have both neuropathy and a foot deformity (hammertoe, bunion, etc.), that creates abnormal pressure points, you have an increased risk of developing a wound. Those that have already had an amputation or prior ulceration are at the highest risk. With this program, I now feel confident about my foot health. 1 Lavery, L.A., Armstrong, David G., Temperature Monitoring to Assess, Predict, and Prevent Diabetic Foot Complications, Lavery and Armstrong; PressureStat, TempStat, Visual Footcare and related marks, images and symbols are the exclusive properties and trademarks of Visual Footcare Technologies, LLC. and are registered or pending with the U.S. Patent and Trademark Office and may be registered or pending with other countries. U.S. Patent No. 7,337,680 and other patents pending. The information provided herein is for educational purposes only. It is not intended to provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual Visual Footcare Technologies, LLC.