Who Needs a Foot Exam?
Current recommendations call for a comprehensive foot examination at least once a year for all patients with type 1 or type 2 diabetes to identify those at high risk for ulceration, which is often a precursor to lower-extremity amputations. Any patient who is identified as being at high risk-that is, the person has loss of protective sensation, absent pedal pulses, foot deformity, history of foot ulceration, and/or a prior amputation-should be evaluated more often. According to the American Diabetes Association, those with neuropathy should have a visual inspection of their feet at every contact with a health care provider.
During the examination, the practitioner should:
* note the history or presence of a foot ulcer
* examine the ankles and feet, including between the toes, noting and documenting any abnormalities of the hair, skin, and nails
* measure and document calluses, lesions, and ulcers
* note and document deformities and atrophy of plantar fat pad
* assess and document pedal pulses
* perform a sensory examination at up to 10 sites with a 5.07 (10-g) Semmes-Weinstein monofilament and note results
* check the patient's footwear for blood or other discharge, abnormal wear patterns, foreign objects, proper fit, appropriate material, and foot protection
* determine and document the patient's education needs and provide information about self-care of the feet and the importance of blood glucose monitoring
* complete a management plan for education, diagnostic studies, footwear recommendations, referrals, and follow-up visits as needed.
A copy of the "Screening Form for Diabetes Foot Disease" can be found online at http://ndep.nih.gov/resources/feet/screenfo.htm.
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