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Diabetes Standards of Care & Clinical Practice Resources

Foot Care

People who have diabetes are at high risk for nerve and vascular damage that can result in loss of protective sensation in the feet, reduced circulation, and poor healing. Foot ulcers and amputations, due to diabetic neuropathy and/or peripheral arterial disease (PAD), are common and preventable causes of disability in adults with diabetes. 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.

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Foot Care Sections

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Clinical Practice Recommendations

Recommendations for Foot Care

Screening

  • Obtain history of ulceration, amputation, Charcot foot, angioplasty or vascular surgery, cigarette smoking, retinopathy, renal disease, vascular disease, and assess symptoms of neuropathy (pain, burning, numbness) and vascular disease (leg fatigue, claudication)
  • At each diabetes visit, inspect patients' feet for acute problems
  • At diabetes diagnosis, and at least annually, perform a comprehensive foot examination to include assessment of:
    • Skin integrity
    • Vascular status including pulses in the legs and feet
    • Foot structure and biomechanics
    • Neurological exam with a 10-g monofilament and at least one other assessment (vibration sensation using a 128-Hz tuning fork, pinprick sensation, or ankle reflexes)
  • Note: After completing a comprehensive foot exam, assign a category of risk for each patient. 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

Treatment

  • Provide risk-appropriate evaluation and monitoring, and refer patients as needed to foot care specialists (podiatrists, wound care specialists), footwear providers, orthopedists, and vascular surgeons. See Diabetes Treatment Algorithm: Foot Care in Type 2 Diabetes
  • Provide self-management education including proper care of the foot, nail and skin care, appropriate footwear, and daily visual inspection of the feet

Clinician and Educator Resources

Diabetes Foot Care CME/CE Training

Diabetes Treatment Algorithm: Foot Care in Type 2 Diabetes

Online CME/CE Education

 

NOTE: Access to this information is not restricted; however, the information found here is intended for use by medical providers. Some videos contain graphic images. Patients should talk with their medical providers about any specific concerns.

NOTE: Access to this information is not restricted; however, the information found here is intended for use by medical providers. Some videos contain graphic images. Patients should talk with their medical providers about any specific concerns.

NOTE: Access to this information is not restricted; however, the information found here is intended for use by medical providers. Some videos contain graphic images. Patients should talk with their medical providers about any specific concerns.

IHS Division of Diabetes Treatment and Prevention


American Diabetes Association Standards of Medical Care in Diabetes - 2018 Exit Disclaimer: You Are Leaving www.ihs.gov 

Diabetes Care 2018 Jan; 41 (Supplement 1)


Comprehensive Foot Examination and Risk Assessment: A report of the Task Force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists Exit Disclaimer: You Are Leaving www.ihs.gov 

Diabetes Care 2008 Aug; 31(8): 1679-1685. doi: 10.2337/dc08-9021


Diabetic Neuropathies: The Nerve Damage of Diabetes Exit Disclaimer: You Are Leaving www.ihs.gov 

National Institute of Diabetes and Digestive and Kidney Diseases


Lower Extremity Amputation Prevention (LEAP) Exit Disclaimer: You Are Leaving www.ihs.gov 

Health Resources and Services Administration


Working Together to Manage Diabetes: A Guide for Pharmacy, Podiatry, Optometry, and Dentistry Exit Disclaimer: You Are Leaving www.ihs.gov 

National Diabetes Education Program