Inspect patients’ feet for acute problems at each diabetes visit.
Perform complete foot examination at least annually to include assessment of protective sensation, foot structure and biomechanics, vascular status, and skin integrity:
Test protective sensation with a 10-gm monofilament and at least 1 of the following: vibration sensation using a 128-Hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold. Assign a category of foot risk for each patient.
Provide risk-appropriate monitoring, treatment, and self-management education, including smoking cessation, as appropriate.
Refer patients as needed to foot care specialists (podiatrists, wound care specialists), footwear providers, orthopedists, and vascular surgeons.
Foot ulcers and amputations due to diabetic neuropathy and/or peripheral arterial disease (PAD) are common, yet often preventable causes of disability in adults with diabetes. Because early identification and management of patients at high risk for foot problems can prevent or delay the onset of adverse outcomes, it is important to evaluate the feet of all patients with diabetes. Categories of risk are defined as:
Low Risk: normal sensory exams, foot structure, vascular status, and skin integrity, and no prior non-traumatic ulcerations.
High Risk: abnormalities on exam or a history of non-traumatic ulcerations.
Since 10-20% of patients with diabetes who present for routine care will have a condition that requires prompt attention (e.g., calluses, bacterial or fungal infections, bulky or ingrown nails, or frank ulceration), it is important to inspect patients’ feet at every diabetes visit, regardless of their risk category.
A cross-training guide to reinforce consistent diabetes messages across the four disciplines – pharmacy, podiatry, optometry, and dentistry (PPOD) -- and to promote a team approach to comprehensive diabetes care that encourages collaboration among all care providers.
IHS Division of Diabetes Treatment and Prevention.
Diabetes Foot Care Hub. Includes CME/CE online, Quick Guide Cards, Treatment Algorithm, educational materials, best practices, and podcasts.
Health Resources and Services Administration.
The Lower Extremity Amputation Prevention (LEAP)
program is a comprehensive 5-step program that can reduce lower extremity amputation rate in individuals with decreased sensation in their feet. Web site includes online course for providers on lower extremity amputation prevention and treatment of the neuropathic foot.
Rith-Najarian S, Branchaud C, Beaulieu O, Gohdes D, Simonson G, Mazze R. Reducing lower-extremity amputations due to diabetes: application of the staged diabetes management approach in a primary care setting. J Fam Pract. 1998;47(2):127-32.