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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?

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