From the Guidelines
Diabetic foot exams should be performed at least once a year for all patients with diabetes, with higher-risk patients requiring more frequent evaluations, specifically every 6-12 months for those classified as IWGDF risk 1, every 3-6 months for IWGDF risk 2, and every 1-3 months for IWGDF risk 3. The frequency of these exams is crucial in preventing foot ulcers and amputations, as diabetes can cause nerve damage and poor circulation, making feet vulnerable to injuries that may go unnoticed 1.
Key Components of Diabetic Foot Exams
- Visual inspection of the feet
- Assessment of pulses
- Testing for loss of protective sensation using a 10g monofilament
- Evaluation of foot biomechanics and footwear During routine diabetes visits, patients should remove their shoes and socks so healthcare providers can perform a brief visual foot check 1.
Importance of Regular Foot Exams
Regular foot examinations are crucial because diabetes can cause nerve damage (neuropathy) and poor circulation, making feet vulnerable to injuries that may go unnoticed and lead to serious infections or ulcers. Early detection of foot problems through regular screening can significantly reduce the risk of complications including amputation 1.
Patient Self-Care
Patients should also perform daily self-examinations of their feet at home, checking for cuts, blisters, redness, swelling, or nail problems. Education on proper foot self-care, including daily foot washing, moisturizing, and proper toenail cutting, is essential for preventing foot ulcers 1.
High-Risk Patients
For patients with risk factors such as previous foot ulcers, peripheral neuropathy, peripheral arterial disease, foot deformities, or a history of amputation, examinations should be conducted more frequently, as specified by the IWGDF risk stratification system 1.
Interprofessional Approach
An interprofessional approach, facilitated by a podiatrist in conjunction with other appropriate team members, is recommended for individuals with foot ulcers and high-risk feet 1.
Therapeutic Footwear
The use of specialized therapeutic footwear is recommended for people with diabetes at high risk for ulceration, including those with loss of protective sensation, foot deformities, ulcers, callous formation, poor peripheral circulation, or history of amputation 1.
From the Research
Diabetic Foot Exam Recommendations
- The frequency of diabetic foot exams is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, the studies emphasize the importance of regular foot care and monitoring for people with diabetes to prevent foot ulcers and amputations.
- Multidisciplinary care, including podiatrists, is recommended for the management of diabetic foot ulcers 4, 5, 6.
- Regular check-ups with a podiatrist or other healthcare professional can help identify potential foot problems early on, reducing the risk of complications 6.
- The American Diabetes Association recommends that people with diabetes have a comprehensive foot exam at least once a year, and more often if they have a history of foot problems or are at high risk for foot complications, although this is not cited in the provided studies.
Risk Factors and Prevention
- Several factors contribute to the development of diabetic foot ulcers, including neurological, vascular, and biomechanical factors 2.
- Regular foot exams and proper foot care can help prevent foot ulcers and amputations 3, 4, 5, 6.
- Interventions such as pressure-relieving footwear, foot skin measurements, and treatment of preulcer signs can reduce the risk of ulcers 2.
- Multidisciplinary care, including podiatrists, infectious disease specialists, and vascular surgeons, can improve outcomes for people with diabetic foot ulcers 2, 4, 5, 6.