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Feet Can Last a Lifetime

II. Current History continued...

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.

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).

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