How often should individuals with diabetes have a foot exam?

Diabetic Foot Examination Frequency

All individuals with diabetes should undergo a comprehensive professional foot examination at least annually, with more frequent examinations (at every healthcare visit) for those with high-risk factors such as loss of protective sensation, prior ulceration or amputation, foot deformities, or peripheral arterial disease. 1, 2

Standard Screening Schedule

Low-Risk Patients (No Risk Factors)

• Annual comprehensive foot examination is the minimum standard for all individuals with diabetes 1
• This applies to newly diagnosed patients and those without neuropathy, peripheral arterial disease, deformities, or history of ulceration 1

High-Risk Patients

More frequent examinations are required for patients with any of the following risk factors: 1

• Loss of protective sensation (LOPS)/peripheral neuropathy: Examination at every healthcare visit 2
• Prior foot ulceration: Examination at every healthcare visit 2
• Prior amputation: Examination at every healthcare visit 1, 2
• Foot deformities (bunions, hammertoes, Charcot joint): More frequent than annual 1
• Peripheral arterial disease: More frequent than annual 1
• Preulcerative corns or calluses: More frequent than annual 1
• Poor glycemic control: More frequent than annual 1
• Nephropathy (especially dialysis or post-transplant patients): More frequent than annual 1
• Retinopathy: More frequent than annual 1
• Smoking: More frequent than annual 1

Components of the Comprehensive Foot Examination

Each professional examination should include: 1

• Skin integrity assessment: Looking for ulcerations, wounds, or breakdown 1
• Loss of protective sensation testing: Using 10-g monofilament plus at least one other neurological test (pinprick, temperature perception, ankle reflexes, or 128-Hz tuning fork for vibratory perception) 1
• Vascular assessment: Palpation of dorsalis pedis and posterior tibial pulses, capillary refill time, rubor on dependency, pallor on elevation, and venous filling time 1
• Structural assessment: Evaluation for foot deformities including bunions, hammertoes, and prominent metatarsals that increase plantar pressures 1

Special Vascular Screening Considerations

All individuals with diabetes over 50 years of age should undergo noninvasive arterial studies (Doppler ultrasound with pulse volume recordings), and if normal, repeat every 5 years. 1 This recommendation comes from the Society for Vascular Surgery and American Podiatric Medical Association guidelines 1

Patient Self-Examination

In addition to professional examinations, all diabetic patients should perform daily self-examination of their feet. 2 This is particularly critical for those with LOPS who may not feel injuries 2. Patients should use visual inspection (with a mirror if needed) or palpation to check for cuts, blisters, redness, swelling, calluses, or temperature changes 2.

Critical Pitfall to Avoid

The most common error is applying the annual examination standard to all diabetic patients uniformly. Peripheral neuropathy was found to be a component cause in 78% of diabetic foot ulcerations, making it essential to identify high-risk patients early and examine them at every visit rather than waiting for the annual examination 1. The presence of even one high-risk factor should trigger more frequent professional surveillance to prevent the progression to ulceration and amputation 1.