JT is a 58-year-old with type 2 diabetes presents for a routine exam. Has a 20-year history of diabetes, hypertension, and peripheral neuropathy. Reports no foot pain, but partner notes they have been walking with a slight limp. On exam, you note dry skin, thickened toenails, a callus on the plantar aspect of the first metatarsal head, and diminished monofilament sensation at multiple sites on both feet. Pedal pulses are diminished bilaterally, and ABI (Ankle-Brachial Index) is 0.6 on the right and 0.7 on the left.
Which of the following is the most appropriate next step in managing this JT’s foot care?
- Refer to a podiatrist for debridement of the callus and initiate custom orthotics.
- Reassure JT that this is only a minor issue since they are not experiencing pain and schedule follow-up in 6 months.
- Prescribe a topical antifungal for the toenails and instruct JT to inspect feet weekly and apply moisturizing cream.
- Recommend vascular imaging and refer to a vascular specialist due to abnormal ABI and diminished pulses.
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