Diabetes Mellitus (Type 1 and Type 2) is a common condition that afflicts many Americans and is being diagnosed more each year! We see many patients who have very subtle symptoms which can be attributed back to early onset and detection of diabetes. Many patients say, “I have a sock balled up feeling under my foot” or “I have severe burning” or “I have tingling in my toes” or “The pain keeps me up at night”. We have learned that these early symptoms or changes are often not being picked up at our patient's primary physician annual physical. The American Diabetes Association (ADA) publishes in their journal “Diabetes Care” annual standards of medical care which our doctors at Foot and Ankle Specialists of the Mid-Atlantic adhere. Additionally, our doctors go beyond the typical evaluation, we are tracking your hemoglobin A1c’s and classifying our patient’s foot risk category at each visit. We feel patients are sometimes seen more frequently in our offices than their primary care. This in turn, allows us an opportunity to be educators from a different perspective that the patient’s primary care physician does not have, more visits give us a unique opportunity to better determine any sensation or structural changes. A typical issue is the early onset of neuropathy, we routinely diagnose and treat this problem. We know that the quality of care provided to a diabetic can critically affect downstream costs both personally and to the healthcare system as a whole. According to Dr. David J. Freedman, it is apparent that ultimately there are potentially significant complications that go with long standing diabetes. Our priority is to provide the highest quality and most appropriate diabetic foot health care. We have learned that some insurance carriers are not evaluating doctors based on high quality, which we feel is a major mistake, but rather only looking at cost. I want our patients to know while this could hurt our profile with certain payers we are taking the high road to high quality. The insurance company’s often times don’t understand that the cost to provide diabetic patient’s with more frequent visits in the long run will greatly reduce costs to the healthcare system.We are evaluating for potential microvascular complications and rendering appropriate foot care. We know patients with diabetes typically may also be developing kidney disease and eye disease issues. We discuss these issues with our patients when appropriate. We are reminding our patients to get their annual eye exam to be tested for retinopathy. We are evaluating our patients for small fiber nerve changes by testing pinprick or temperature sensation changes. We use a 128-Hz tuning fork to test for vibratory changes and 10-g monofilament test to identify areas at risk for ulceration. Using these testing techniques, we are looking for advancing neuropathy changes which usually indicate large fiber changes when there is numbness and loss of protective sensations. We are evaluating and treating diabetic patients with foot deformities, foot ulcers and ultimately developing ways to prevent future complications on a patient by patient basis. While we can’t eliminate a patient’s advanced vascular changes, we do evaluate for PAD (peripheral arterial disease) and refer our patients to interventional and vascular specialists to assist in establishing better blood flow to our patients feet. This is just another reason why patients with diabetes need to see a doctor with Foot and Ankle Specialists of the Mid-Atlantic, according to Dr. David J. Freedman. We provide the necessary evaluations which is best to detect these early and later changes. We are in a unique position to provide this value added service to our patient’s feet. There is not a day that goes by that a diabetic patient who is at risk, has improper shoes. We agree with the ADA’s recommendation of getting our patients into specialized therapeutic footwear. We provide self-care education to all our patients. We educate our patients that use tobacco products, why they must quit in order to reduce the increasing complications in their feet and legs.If you haven’t made an appointment to get your diabetic evaluation, make an appointment today with a podiatrist near you. Our care team is looking to reduce risks. We are evaluating more closely our patients that have been diagnosed as pre-diabetics as well as looking at BMI. Foot and Ankle Specialists of the Mid-Atlantic feels the reason to be seen by one of our doctors has to do with our ability to determine the risk factors associated with patients developing telltale signs of potential future advancing diabetes potential complications. Our thought process at Foot and Ankle Specialists of the Mid-Atlantic is to intervene earlier in an attempt to prevent the potential complications from the many issues that diabetes throws your way. Dr. David J. Freedman works in our Silver Spring, MD (International Dr) office.
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