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Feet Can Last a Lifetime

V. Risk Categorization continued...


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.

VI. Footwear Assessment

Improper or poorly fitting shoes are major contributors to diabetes foot ulcerations. Counsel patients about appropriate footwear. All patients with diabetes need to pay special attention to the fit and style of their shoes and should avoid pointed-toe shoes or high heels. Properly fitted athletic or walking shoes are recommended for daily wear. If off-the-shelf shoes are used, make sure that there is room to accommodate any deformities.

High risk patients may require therapeutic shoes, depth-inlay shoes, custom-molded inserts (orthoses), or custom-molded shoes depending on the degree of foot deformity and history of ulceration.

  • Shoe must protect and support the feet
  • Shoe must accommodate foot deformaties
  • Shoe shape must match foot shape

VII. Education

Indicate whether the patient has received prior education by checking yes or no in the blank. Patient education is an essential component of preventive care.

VIII. Management Plan

Complete the management plan, indicating actions for patient education, any diagnostic studies, footwear recommendations, referrals, and follow-up care. Note: The management of foot problems may be the responsibility of different health care providers. For example, in some communities, certified nurses provide home health services or practice in primary care or foot care clinics to provide specialized diabetes foot care.


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

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