One in 100 persons with diabetes faces risk of developing foot ulcer in his/her lifetime. Hence, a careful inspection of the feet should be done by a qualified podiatrist for all diabetics at every 6 months interval. Routine foot checks should include examination of the bare feet for signs of bruises, deformities or loss of sensation. If abnormalities are present, more frequent evaluation of the diabetic foot is recommended depending on risk category.
Patient education for foot care at home is also plays a very vital role in prevention of foot ulcers. Simple guidelines regarding use of right footwear, walking techniques, use of cosmetics, trimming nails, etc can ensure that the patient is well-informed and cautious about their feet.
Components of the diabetic foot Inspection
Dermatologic
- skin status: color, thickness, dryness, cracking
- sweating
- infection: check between toes for fungal infection
- ulceration
- calluses/blistering: hemorrhage into callus?
Musculoskeletal
- deformity, e.g., claw toes, prominent metatarsal heads, Charcot joint (unilateral red, hot, swollen, flat foot with profound deformity)
- muscle wasting (guttering between metatarsals)
Neurological assessment 10-g monofilament (see image) + 1 of the following 4
- vibration using 128-Hz tuning fork
- pinprick sensation
- ankle reflexes
- Vibration perception threshold testing
Vascular assessment
- foot pulses
- ankle brachial pressure index (measuring blood pressure at the ankle), if indicated
Risk assessment, careful inspection and timely intervention can help reduce mortality related to leg and foot ulcers which often reduces life span of these patients compared to non ulcerated diabetics.
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4860228/
http://care.diabetesjournals.org/content/31/8/1679
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