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
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
- 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
Demonstrate self-care techniques.
Prescribe appropriate footwear.
Give positive feedback for proper foot
Give patients the self-care booklet or tip
sheet in this kit.
Counsel about smoking cessation if
Reinforce the importance of blood glucose
control to reduce the risk for foot problems and other
4. Follow Up with High Risk Patients
Place "high risk feet" stickers on
Examine feet at every visit.
Prescribe special inserts and shoes as
Refer to specialists for a risk factor you
Provide education about self-care.
Ensure that the elderly and blind have help
for daily foot care.
Assess metabolic control.
Foot Screening Instructions
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
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
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.