During the physical examination you noticed some changes in Mrs Cloverdale’s feet, so you refer her for a Podiatric consult. You are concerned that the diabetes and arthritis may have caused changes in her feet that are further adding to her falls risk.  Corns, calluses and age-related gait changes can also add to falls risk, so you feel that a podiatric consult is good option.

The podiatrist confirms bilateral loss of vibration sensation to the metatarsal heads and touch sensation to the ball of the feet and toes as tested with 10g molofilament. Her circulation was found to be reasonable with an absent dorsalis pedis pulse and palpable posterior tibial pulse. Her ankle-brachial index was minimally outside normal range at 0.8. The podiatrist remarked that Mrs Cloverdale had significant structural foot problems, including bilateral hallux valgus and claw toe deformities with associated painful digital corns and plantar calluses. Her footwear was deemed to be inappropriate and more supportive lower-heeled shoes with Velcro straps were recommended.   The podiatrist recommended regular podiatry management to help keep Mrs Cloverdale’s feet relatively pain-free and to monitor her lower limb neurovascular status.