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
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
- 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
- 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