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Regular inspection and examination of the foot at risk
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All diabetic patients should be examined at least once a year for potential foot problems, and patients with demonstrated risk factor(s) should be examined more often (every 1-6 months). The absence of symptoms does not mean that the feet are healthy, since the patient can have neuropathy, peripheral vascular disease or even an ulcer without any complaints. The feet should be examined with the patient lying down and standing up, and the shoes and socks should also be inspected.
History and examination
History |
Previous ulcer/amputation
Previous foot education
Social isolation
Poor access to healthcare
Bare-foot walking |
Neuropathy |
Symptoms, such as tingling or pain Loss of sensation |
Vascular status |
Claudication
Rest pain
Pedal pulses Discoloration (rubor) on dependency color
Temperature
Edema Nail pathology (e.g. ingrown nails)
Wrongly cut nails |
Skin |
Ulcer. Callus, dryness, cracks, interdigital maceration |
Bone/joint |
Deformities (e.g. claw toes, hammer toes) or bony prominences Loss of mobility (e.g. hallux rigidus) |
Footwear/stockings |
Assessment of both inside and outside |
Sensory loss due to diabetic polyneuropathy can be assessed using the following techniques:
Pressure perception |
Semmes-Weinstein monofilaments (7 O gram, see addendum )
The risk of future ulceration can be determined with a 10 gram monofilament
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Vibration perception |
128 Hz tuning fork (hallux, see addendum )
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Discrimination |
Pin prick (dorsum of foot, without penetrating the skin)
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Tactile sensation |
Cotton wool (dorsum of foot)
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Reflexes |
Achilles tendon reflexes |
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