Yearly Exams Help Avoid Serious Foot Problems

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Comprehensive foot examination and risk assessment, by Andrew J.M. Boulton and colleagues. Diabetes Care 31:1679-1685, 2008

What is the problem and what is known about it so far?

People with diabetes are at high risk for diabetic foot ulcers, which are painful sores that are slow to heal and often become deep and infected. High blood glucose levels, over time, can reduce blood flow needed to keep feet healthy, and diabetic nerve damage can limit a person's ability to feel a foot sore until it has become very serious. Left untreated, diabetic foot ulcers can lead to amputations, removal of the foot by surgery. The American Diabetes Association (ADA) recommends that people with diabetes take good care of their feet and check them daily for cracks or sores. In addition, people with diabetes should have a complete foot exam every year.

Why did researchers do this particular study?

The ADA formed a task force of health care professionals to make any needed updates to its guidelines about what should be included in an annual foot exam for adult patients with diabetes.

How was the study done?

The task force reviewed medical studies about diabetic foot problems that had been conducted in the 10 years since the ADA last updated its foot care guidelines. Based on that information, the task force recommended updates to the ADA's foot care guidelines.

What did the researchers recommend?

Adults with diabetes should have a foot exam every year. During this exam, the doctor should:

• Find out about any previous foot problems, amputations, tobacco use, and nerve, eye, kidney, and blood vessel problems
• Carefully inspect the patient's bare feet and make sure the patient's shoes are well-fitting, comfortable, and unlikely to cause injuries or sores
• Inspect the skin on the patient's feet, including between the toes, for signs of ulcers, blisters, red spots, calluses, toenail problems, or hot or cold areas and refer all such problems to a specialist.
• Inspect the bones and muscles of the patient's feet to look for abnormal shapes that could lead to foot ulcers or other problems, and refer the patient to a specialist if needed.
• Check to find out whether the patient has lost feeling in the feet. This should involve a simple touch test using a tool called a 10-gram monofilament and may also include other simple tests of sensation in the feet, such as tuning-fork vibrations or pinpricks.
• Check the blood flow to the feet by checking foot pulses and sometimes blood pressure at the ankle, and refer to a specialist if needed.
• Assign the patient a "foot risk category" to help guide future therapy, specialty care, and the number of follow-up visits.

What are the implications of the study?

Diabetic foot problems are very common but can be avoided or lessened with proper care. People with diabetes should take good care of their feet daily and should receive a thorough foot exam every year. A foot exam is a simple, effective way to catch foot problems early and avoid serious complications.

FOR MORE INFORMATION

Diabetes and foot complications

Diabetes and blood flow problems

Foot care tips