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Feet Can Last a Lifetime

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.

Risk Category Defined

Management Guidelines

Low Risk Patients
None of the five high risk characteristics below.

Conduct an annual foot screening exam.
Assess/recommend appropriate footwear.
Provide patient education for preventive self-care.

High Risk Patients
One or more of the following:
Loss of protective sensation
Absent pedal pulses
Severe foot deformity
History of foot ulcer
Prior amputation

Conduct foot assessment every 3 months.
Demonstrate preventive self-care of the feet.
Refer to specialists and a diabetes educator as indicated.(Always refer to a specialist if Charcot joints are suspected.)
Assess/prescribe appropriate footwear.
Certify Medicare patients for therapeutic shoe benefits.
Place "High Risk Feet" sticker on medical record.

Management Guidelines for Active Ulcer or Foot Infection

  • Never let patients with an open plantar ulcer walk out in their own shoes. Weight relief must be provided.
  • Assess/prescribe therapeutic footwear to help modify weight bearing and protect the feet.
  • Conduct frequent wound assessment and provide care as indicated.
  • Demonstrate preventive self-care of the feet.
  • Provide patient education on wound care.
  • Refer to specialists and a diabetes educator as indicated.
  • Certify Medicare patients for therapeutic footwear benefits (after ulcer heals).
  • Place "High Risk Feet" sticker on medical record.

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