SUBJECTIVE: The patient returns for diabetic foot care. He complains of long nails and calluses. He denies any change in his health since his last visit.
OBJECTIVE: Examination reveals continued findings consistent with PVD with nonpalpable pulses, dry, atrophic, hairless skin, and slight decreased skin temperature. His nails are elongated, one through five bilaterally. There are continued hyperkeratotic lesions on the plantar medial aspect of the first metatarsal head bilaterally, as well as on the distal medial aspect of the first digit. Hallux nails, mycotic and thickened with periungual erythema. Previously noted tinea pedis has resolved.
ASSESSMENT: Diabetes, peripheral vascular disease, onychauxis, hyperkeratosis.
TREATMENT: Diabetic foot care performed. Examination and evaluation performed. Debridement of nails performed, one through five bilaterally, with complete debridement of hallux nails. Debridement of hyperkeratotic lesions performed as noted.
PLAN: The patient will return in three months for continued care.
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SUBJECTIVE: The patient returns for continued diabetic foot care. She denies any change in her health since her last visit. She complains of long nails and calluses. She continues in custom shoes.
OBJECTIVE: Examination reveals continued findings consistent with peripheral neuropathy. There is ongoing and stable Charcot-like deformity on her left foot. Her nails are elongated, one through five bilaterally. There are hyperkeratotic lesions on the margins of both heels and the longitudinal arch of the left foot.
ASSESSMENT: Diabetes and neuropathy, onychauxis, hyperkeratosis.
TREATMENT: Examination and evaluation performed. Debridement nails performed, one through five bilaterally. Debridement of hyperkeratotic lesions performed as noted.
PLAN: The patient will return in three months for continued care.
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SUBJECTIVE: The patient returns for diabetic foot care. She was seen last month for an infected bursitis of the left first metatarsal. She says this has been more comfortable since her last visit, but the painful callus has recurred. She denies any change in her health since her last visit.
OBJECTIVE: Examination reveals reformation of a large painful hyperkeratotic lesion on the dorsal medial aspect of the first metatarsal of her right foot. The area continues painful and swollen over a bunion deformity. Her nails are elongated, one through five bilaterally with some thickened changes and significant incurvation of both margins of both hallux nails with periungual hyperkeratosis in the nail grooves.
Continued findings consistent with PVD with nonpalpable pulses, dry, atrophic, hairless skin, decreased skin temperature.
ASSESSMENT: Diabetes mellitus, onychauxis, multiple hyperkeratoses, peripheral vascular disease.
TREATMENT: Examination and evaluation performed. Debridement of nails performed, one through five bilaterally. Both margins of both hallux nails are redefined with debridement of periungual hyperkeratosis. Debridement of the painful callus in the first metatarsal head of left foot performed. Accommodative padding applied.
PLAN: The patient will return for continued diabetic foot care in 10 weeks.
