Podiatry: Tracking the Diabetic Foot

Repeated care, a memory that must keep up

Podiatry is built on brief, repeated appointments: one session, a few weeks later another, and in between nothing written down if you're not careful. When it comes to an isolated ingrown toenail, losing that information doesn't matter much. With a diabetic patient, it does.

Diabetes is common in Algeria, and the diabetic foot remains one of the leading causes of preventable hospitalization. The podiatrist is often the professional who sees the foot most regularly: they are the one who spots the pressure hotspot before ulceration develops, the loss of sensation before the painless wound appears.

What the patient record must capture

• Podiatric assessment: skin and nail condition, hyperkeratosis, deformities;
• static assessment: weight distribution, foot morphology, alignment;
• dynamic assessment: gait pattern, limping, shoe wear;
• weight-bearing type: neutral, overpronation, supination;
• diabetic foot monitoring: to be checked when applicable, along with the risk level;
• orthotic insoles: prescribed, made, worn.

That last point deserves particular attention. An insole that was prescribed but never worn — and the reason given by the patient, whether discomfort, ill-fitting shoes, or cost — often explains a recurrence far better than any biomechanical theory.

Taking a photo is not the same as documenting

Many practitioners take a photo of the foot with their phone. It's useful, but not enough as long as that image sits in a personal camera roll: impossible to retrieve six months later, impossible to share properly, and problematic from a patient confidentiality standpoint.

A photo filed in the patient record, dated, alongside the written notes from that day, takes on a different status: it becomes part of the ongoing record, directly comparable to what was seen at the previous visit.

The risk level determines the follow-up schedule

Diabetic foot monitoring is organized around a straightforward, internationally recognized risk gradient: no neuropathy or arteriopathy; isolated neuropathy; neuropathy combined with arteriopathy or deformity; history of ulceration or amputation. The higher the grade, the closer the follow-up needs to be.

Recording this grade in the patient file — rather than simply writing "diabetic patient" — changes how care is delivered: it sets the frequency of appointments, justifies the prescription of insoles, and explains to the patient why they are being seen so often. It also gives the record continuity when the patient is seen by a colleague during an absence.

The link with the physician

Podiatry is often practiced without a referral, but rarely in isolation. A suspicious lesion, a sign of arteriopathy, a wound that won't heal — all of these call for a prompt return to the primary care physician or diabetologist.

That handoff is better written than spoken: a brief report, on clinic letterhead, stating what was observed, what was done, and what is being requested. Shared via a read-only link or by email, it leaves a record on both sides — and that record protects the patient as much as the practitioner.

Managing a series of appointments

Podiatry care for at-risk patients is readily scheduled in series: every six to eight weeks. Booking the full series at once, accounting for days off and already-filled slots, avoids phone reminders and missed appointments — and a missed appointment for a diabetic patient carries a real cost.

Billing follows the same logic: a podiatry session and the fitting of orthotic insoles are not billed the same way, and the correct code must be selected at the moment the appointment is marked as completed, not pieced together at the end of the month.

In practice

In Hakim-DZ's allied health module, the podiatry assessment includes its own dedicated fields, covering diabetic foot monitoring and insole tracking; appointments can be scheduled as a series in the calendar, each completed session is billed with the appropriate code, and the session report can be printed or shared directly with the referring physician.

See the Allied Health page.