Regular examination and follow-up process aimed at evaluating the risk of neuropathy, vascular disease, and infection in diabetes and at preventing foot ulcers and amputations.
Indication
- At least one comprehensive foot examination per year in all patients with diabetes (every 3-6 months in high-risk patients)
- Patients reporting numbness, tingling, burning, pain, or sensory loss in the feet
- Calluses, fissures, blisters, open wounds, nail deformities, or toe/foot deformities (suspicion of Charcot foot)
- Leg pain on walking (claudication), rest pain, or cold-pale foot (suspicion of peripheral arterial disease)
- Patients with a previous history of foot ulcers, toe or foot amputation
- Diabetic patients with vision loss or those unable to perform foot care alone
Preparation
- Wash the feet before the examination and arrive with them clean and dry; remove nail polish and corn pads
- Bring your regularly worn shoes and socks for examination (internal pressure points can be evaluated)
- Bring previous blood glucose and HbA1c results, and any vascular Doppler ultrasound reports
- A relative or caregiver may accompany the visit to receive foot care education
How it's performed
- A detailed history is taken: ulcer history, foot pain, sensory loss, walking distance, and smoking are reviewed
- Visual examination evaluates skin color, dryness, fissures, calluses, blisters, ulcers, toe deformities, and nail changes
- Neurological examination includes the 10 g monofilament test (at 10 sites), vibration sensation with a 128 Hz tuning fork, pinprick sensitivity, and the Achilles reflex
- Vascular evaluation includes palpation of the dorsalis pedis and posterior tibial pulses; the ankle-brachial index (ABI) is measured when needed (ABI <0.9 is pathologic)
- Any existing wound is graded by the Wagner classification: Grade 0 (no wound, deformity present), 1 (superficial ulcer), 2 (deep ulcer with tendon/joint involvement), 3 (osteomyelitis/abscess), 4 (localized gangrene), 5 (extensive gangrene)
- Structured education on foot care, footwear selection, and daily inspection is provided
Post-procedure
- Annual screening is sufficient for low-risk patients; examination every 1-3 months is recommended for those with neuropathy, vascular disease, or a history of ulcer
- If a wound or infection is detected, follow-up is provided by a multidisciplinary team (endocrinology, plastic/general surgery, vascular surgery, infectious diseases, orthopedics)
- The need for orthopedic insoles or special footwear (therapeutic shoes) is evaluated
- Smoking cessation is supported; blood pressure and lipid control are tightened
- The patient is taught daily foot inspection, avoiding walking barefoot, lukewarm foot baths (avoiding hot water), and trimming nails straight across
Risks
- The examination itself is low-risk and painless; minor discomfort may occur during the monofilament or pinprick test
- Missed or late-diagnosed ulcers may progress to deep tissue infection, osteomyelitis, and sepsis
- If peripheral arterial disease is not recognized, wounds do not heal due to insufficient blood supply, and amputation risk increases
- Improper footwear or incorrect nail trimming may cause new wounds
- Charcot foot (neuropathic arthropathy), if not diagnosed early, leads to permanent bone deformity
FAQ
Why is a diabetic foot examination so important?
In diabetes, sensory loss (neuropathy) and vascular damage allow small wounds to grow unnoticed and become infected. Regular examination identifies risk factors early; a significant proportion of wounds and amputations can be prevented.
How should I check my feet at home?
Inspect your feet daily (especially between the toes and on the sole) under good lighting; use a mirror if needed. Consult your physician if you notice redness, blisters, fissures, cuts, or calluses. Dry your feet with a soft towel and keep the spaces between the toes dry.
What kind of shoes should I choose?
Choose shoes with a wide toe box, soft insole, no or minimal seams, breathability, a snug fit, and a low heel. Break in new shoes gradually; never walk barefoot, and use appropriate slippers indoors as well.
What should I do if a wound develops?
Contact your physician without delay even for a small cut or blister. Clean the wound and keep it clean and dry; do not apply homemade ointments or salt. Fever, swelling, foul odor, or wound enlargement requires urgent evaluation.
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