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Feet Can Last a Lifetime

Steps for Preventing Diabetes Foot Problems

1. Screen Feet Annually

Conduct a physical exam and a sensory exam using a monofilament.

Assess and document your patient's foot condition.

2. Categorize Your Findings

Low Risk Patient -- All of the following:

  • Intact protective sensation
  • Pedal pulses present
  • No severe deformity
  • No prior foot ulcer
  • No amputation

 

High Risk Patient -- One or more of the following:

  • Loss of protective sensation
  • Absent pedal pulses
  • Severe foot deformity
  • History of foot ulcer
  • Prior amputation

 

3. Counsel Your Patients or Refer to a Diabetes Educator

Talk with your patients about their risk category.

Demonstrate self-care techniques.

Prescribe appropriate footwear.

Give positive feedback for proper foot care.

Give patients the self-care booklet or tip sheet in this kit.

Counsel about smoking cessation if needed.

Reinforce the importance of blood glucose control to reduce the risk for foot problems and other complications.

4. Follow Up with High Risk Patients

Place "high risk feet" stickers on medical record.

Examine feet at every visit.

Prescribe special inserts and shoes as needed.

Refer to specialists for a risk factor you cannot rectify.

Provide education about self-care.

Ensure that the elderly and blind have help for daily foot care.

Assess metabolic control.

Foot Screening Instructions

Screening Objectives

Completing the "Foot Screening Instructions" will enable you to:

Quickly identify the patient with current foot problems or a foot at risk for developing problems.

Obtain the information needed to:

  • Make an initial diagnosis of a foot problem.
  • Develop a treatment plan.
  • Identify needs for referral to foot care specialists.
  • Schedule follow-up examinations.

Document the level of foot deformity and/or disability.

Determine the need for therapeutic footwear.

Refer for diabetes education.

Compare future examinations with this baseline information.

I. Medical History

Patients who have been diagnosed with any of the medical problems listed are likely to have had diabetes for several years and to be at risk for foot problems. If the patient is unable to feel the 10-gram monofilament on any site on either foot, he or she has peripheral neuropathy.

II. Current History

Question 1: Any change in the foot since the last evaluation?

This question is to determine whether the patient has experienced any change in the strength or sensation in the feet. If this is the patient's first visit, enter N/A unless the patient has noticed a change in the past year.

Question 2: Does the patient have a foot ulcer now or a history of foot ulcer?

A positive history of a foot ulcer places the patient permanently in the high risk category. This person always has an increased risk for developing another foot ulcer, progressive deformity of the foot, and, ultimately, lower limb amputation.

Question 3: Is there pain in the calf muscles when walking -- i.e., pain occurring in the calf or thigh when walking less than one block that is relieved by rest?

This question is to determine whether the patient experiences intermittent claudication when walking. This pain is an indication of peripheral vascular disease or impaired circulation.

WebMD Public Information from the U.S. National Institutes of Health

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If the level is below 70 or you are experiencing symptoms such as shaking, sweating or difficulty thinking, you will need to raise the number immediately. A quick solution is to eat a few pieces of hard candy or 1 tablespoon of sugar or honey. Recheck your numbers again in 15 minutes to see if the number has gone up. If not, repeat the steps above or call your doctor.

People who experience hypoglycemia several times in a week should call their health care provider. It's important to monitor your levels each day so you can make sure your numbers are within the range. If you are pregnant always consult with your health care provider.

Congratulations on taking steps to manage your health.

However, it's important to continue to track your numbers so that you can make lifestyle changes if needed. If you are pregnant always consult with your physician.

Your level is high if this reading was taken before eating. Aim for 70-130 before meals and less than 180 two hours after meals.

Even if your number is high, it's not too late for you to take control of your health and lower your blood sugar.

One of the first steps is to monitor your levels each day. If you are pregnant always consult with your physician.

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