Well I have the fitting shoes answer confirmed in
http://www.amazon.com/Davidsons-Pri...&sr=8-1&keywords=Davidssons+internal+medicine
So unless your answer key was provided by NBME I would take the answer keys answers with a big grain of salt.
Uptodate: Patient information: Foot care in diabetes mellitus (Beyond the Basics) PREVENTING FOOT PROBLEMS IN DIABETES — Controlling blood sugar levels can reduce the blood vessel and nerve damage that often lead to diabetic foot complications. If a foot wound or ulcer does occur, blood sugar control reduces the risk of requiring amputation. (See "Patient information: Self-blood glucose monitoring in diabetes mellitus (Beyond the Basics)".)
Foot care is important, although patients should also continue to follow other general guidelines for managing diabetes.
The following strategies can reduce the chances of developing foot problems.
Quit smoking — Smoking can worsen heart and vascular problems and reduce circulation to the feet. (See "Patient information: Quitting smoking (Beyond the Basics)".)
Avoid activities that can injure the feet — Some activities increase the risk of foot injury and are not recommended, including walking barefoot, using a heating pad or hot water bottle on the feet, and stepping into the bathtub before testing the temperature.
Use care when trimming the nails — Trim the toe nails along the shape of the toe and file the nails to remove any sharp edges (figure 1). Never cut (or allow a manicurist to cut) the cuticles. Do not open blisters, try to free ingrown toenails, or otherwise break the skin on the feet. See a healthcare provider or podiatrist for even minor procedures.
Wash and check the feet
daily — Use lukewarm water and mild soap to clean the feet. Gently pat your feet dry and apply a moisturizing cream or lotion.
Check the entire surface of both feet for skin breaks, blisters, swelling, or redness, including between and underneath the toes where damage may be hidden. Use a mirror if it is difficult to see all parts of the feet or ask a family member or caregiver to help.
Choose socks and shoes carefully — Select cotton socks that fit loosely, and change the socks every day.
Select shoes that are snug but not tight, and break new shoes in slowly to prevent any blisters (figure 2). Ask about customized shoes if the feet are misshapen or have ulcers; specialized shoes can reduce the chances of developing foot ulcers in the future. Shoe inserts may also help cushion the step and decrease pressure on the soles of the feet.
Ask for foot exams — Screening for foot complications should be a routine part of most medical visits, but is sometimes overlooked. Don't hesitate to ask the healthcare provider for a foot check at least once a year, and more frequently if there are foot changes.
Uptodate: Evaluation of the Diabetic Foot
Preventive foot care — In conjunction with screening, counseling regarding preventive foot care should be given to any patient whose feet are at risk. (See "Patient information: Foot care in diabetes mellitus (Beyond the Basics)".) There are a series of recommendations that can markedly diminish ulcer formation; they are particularly important in patients with existing neuropathy.
Avoid smoking, walking barefoot, the use of heating pads or hot water bottles, and stepping into a bath without checking the temperature.
The toenails should be trimmed to the shape of the toe and filed to remove sharp edges.
The feet should be inspected daily, looking between and underneath the toes and at pressure areas for skin breaks, blisters, swelling, or redness. The patient may need to use a mirror or, if vision is impaired, have someone else perform the examination.
The patient's shoes should fit properly and not be too tight, and the socks should be cotton, loose fitting, and changed every day. Patients who have misshapen feet or have had a previous foot ulcer may benefit from the use of special customized shoes. A prospective study found that shoe variables other than the recommendation for customized shoes (eg, style, width, length, or type of shoe) had no preventive effect [31]. The use of customized shoes, however, reduced the development of new foot ulcers from 58 to 28 percent over one year of follow-up in a second report [32]. In a third review, the use of a viscoelastic insole in conjunction with well-fitting shoes (whether customized, standard "comfort" or athletic shoes) was associated with a decrease in plantar pressure; whether this results in a reduced incidence of foot ulcers remains to be determined [33].
The feet should be washed daily in lukewarm water. Mild soap should be used and the feet should be dried by gentle patting. A moisturizing cream or lotion should then be applied.
A particularly effective strategy is to make specific recommendations to the patient in the form of a "contract" and to advise the patient to request that his or her feet be examined at every visit to the doctor or nurse [34].
In addition to the foot care measures described above, preliminary data suggest that home temperature monitoring may be effective in preventing foot ulceration in very high risk patients (for example, those with severe neuropathy and a history of prior amputations or ulcers) [35,36]. Temperature monitoring involves daily or twice daily measurements of skin surface temperature with a thermometer equipped with a touch sensor. If a temperature difference (elevation) is detected between a right and left foot site (figure 1), patients are instructed to reduce activity until the temperature normalizes. Whether the benefit of monitoring temperature is specifically related to the monitoring, or the heightened attention to foot care in those performing the monitoring, is not clear. Additional efficacy and feasibility studies are required before home temperature monitoring can be recommended to reduce the risk of foot ulcers.
Cool. just fyi.
