Best Practices for Maintaining Healthy Legs
Regular foot examinations and proper foot care are essential for maintaining healthy legs, especially for individuals with risk factors such as diabetes, peripheral arterial disease, or neuropathy.
Regular Assessment and Examination
- Perform comprehensive foot evaluations at least annually to identify risk factors for ulcers and amputations 1
- The examination should include:
- Inspection of skin integrity
- Assessment of foot deformities
- Neurological assessment (10-g monofilament testing with at least one other assessment: pinprick, temperature, vibration)
- Vascular assessment including pulses in the legs and feet 1
- Individuals with evidence of sensory loss, prior ulceration, or amputation should have their feet inspected at every visit 1
- For high-risk individuals (e.g., those with diabetes), biannual foot examination by a clinician is reasonable 1
Vascular Health Management
- Initial screening for peripheral arterial disease (PAD) should include assessment of:
- Lower-extremity pulses
- Capillary refill time
- Rubor on dependency
- Pallor on elevation
- Venous filling time 1
- Patients with symptoms of claudication or decreased/absent pedal pulses should be referred for ankle-brachial index and further vascular assessment 1
- For individuals with PAD, a supervised exercise program is beneficial to improve walking ability and functional status 1
- Smoking cessation is crucial for those with PAD or other vascular conditions 1
Foot Care Practices
- Provide general preventive foot self-care education to all individuals, especially those with diabetes 1
- Daily self-inspection of feet is recommended for early detection of problems 1
- Proper footwear selection is critical, particularly for high-risk individuals 1
- Specialized therapeutic footwear is recommended for high-risk patients, including those with:
- Severe neuropathy
- Foot deformities
- Ulcers
- Callous formation
- Poor peripheral circulation
- History of amputation 1
Exercise and Activity
- Regular physical activity improves leg circulation and muscle strength 1
- For individuals with PAD and claudication, structured exercise programs that include:
- Supervised exercise sessions
- Walking exercises to near-maximal pain
- Intermittent walking to moderate-to-maximum claudication
- Sessions lasting 30-45 minutes
- At least 3 sessions per week
- Programs lasting at least 12 weeks 1
- Alternative exercise modes such as upper-body ergometry, cycling, and pain-free or low-intensity walking can be beneficial for improving walking ability and functional status in PAD patients 1
Risk Factor Management
- Maintain proper glycemic control for individuals with diabetes 1
- Treat hypertension appropriately to reduce cardiovascular risk 1
- Manage lipid levels with appropriate medications when indicated 1
- Prompt diagnosis and treatment of foot infections are essential to avoid amputation 1
Multidisciplinary Approach for High-Risk Individuals
- A multidisciplinary approach is recommended for individuals with:
- Foot ulcers
- High-risk feet (e.g., dialysis patients)
- Charcot foot
- Prior ulcers or amputation
- Peripheral arterial disease 1
- Refer patients who smoke or have histories of prior lower-extremity complications, loss of protective sensation, structural abnormalities, or peripheral arterial disease to foot care specialists for ongoing preventive care and lifelong surveillance 1
By following these evidence-based practices, individuals can significantly reduce their risk of leg problems and maintain optimal leg health throughout their lifetime.