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Feet Can Last a Lifetime

III. Foot Exam

Item 1: Are the nails thick, too long, ingrown or infected with fungal disease?

Thick nails may indicate vascular or fungal disease. If severe nail problems are present, refer the patient to a podiatrist or a nurse foot care specialist.

Item 2: Foot Deformities

Indicate foot deformities listed or specify the type and date of amputation(s). The more serious deformities are illustrated below. Prominent metatarsal heads are evidence of major deformity such as midfoot collapse.

a.Toe Deformities (Hammer/Claw Toes)
b. Bunions (Hallux Valgus)
c. Plantar View of Charcot Joint

Item 3: Pedal Pulses

Check the pedal pulses in both feet and note whether they are present or absent.

Item 4: Skin Condition

Examine each foot and record the problems identified by drawing or labeling the condition on the foot diagram. If there are calluses, pre-ulcerative lesions (a closed lesion, such as a blister or hematoma), or open ulcers, measure and draw them in and use the appropriate symbol to indicate what type of lesion is present. Label areas that are significantly red, warm (warmer than the other parts of the foot or the opposite foot), dry, or macerated (friable, moist, soft tissue).

IV. Sensory Foot Exam

The sensory testing device used to complete a foot exam is a 10-gram (5.07 Semmes-Weinstein) nylon filament mounted on a holder that has been standardized to deliver a 10-gram force when properly applied. Research has shown that a person who can feel the 10-gram filament in the selected sites is at reduced risk for developing ulcers.

  • The sensory exam should be done in a quiet and relaxed setting. The patient must not watch while the examiner applies the filament.
  • Test the monofilament on the patient's hand so he/she knows what to anticipate.
  • The five sites to be tested are indicated on the screening form.
  • Apply the monofilament perpendicular to the skin's surface (see diagram A below).
  • Apply sufficient force to cause the filament to bend or buckle (see diagram B below).

  • The total duration of the approach, skin contact, and departure of the filament should be approximately 1-1/2 seconds.
  • Apply the filament along the perimeter and not on an ulcer site, callus, scar or necrotic tissue. Do not allow the filament to slide across the skin or make repetitive contact at the test site.
  • Press the filament to the skin such that it buckles at one of two times as you say "time one" or "time two." Have patients identify at which time they were touched. Randomize the sequence of applying the filament throughout the examination.

 

V. Risk Categorization

Based on the foot exam, determine the patient's risk category. A definition of "low risk" or "high risk" for recurrent ulceration and ultimately, amputation, is provided in the chart below along with minimum suggested management guidelines. Individuals who are identified as "high risk" may require a more comprehensive evaluation.

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

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