What are the findings of a diabetic foot examination?

From the Guidelines

The diabetic foot examination is a crucial assessment that includes a detailed history and thorough examination of the feet to identify potential complications in patients with diabetes.

Key Components of the Examination

• A detailed history documenting diabetes management, smoking history, exercise tolerance, history of claudication or rest pain, and prior ulcerations or amputations 1
• Assessment of skin integrity to identify any preulcerative lesions or foot deformities such as bunions, hammertoes, and prominent metatarsals 1
• Neurological evaluation using the 10-g monofilament along with at least one other neurological assessment tool to assess for peripheral neuropathy 1
• Vascular assessment including pulse examination of the dorsalis pedis and posterior tibial arteries to identify peripheral arterial disease (PAD) 1 The examination should be performed annually in all people with diabetes and more frequently in at-risk individuals, such as those with a history of prior ulceration or amputation 1.

Identification of At-Risk Feet

Factors associated with the at-risk foot include poor glycemic management, peripheral neuropathy, PAD, foot deformities, preulcerative corns or calluses, prior ulceration, prior amputation, smoking, retinopathy, and nephropathy 1. Early recognition of at-risk feet, preulcerative lesions, and prompt treatment of ulcerations and other lower-extremity complications can delay or prevent adverse outcomes 1.

From the Research

Diabetic Foot Examination Findings

The findings of a diabetic foot examination include:

• Dermatological, vascular, neurological, and musculoskeletal systems assessment 2
• Identification of risk factors such as peripheral neuropathy, minor foot trauma, and foot deformity 2, 3
• Detection of peripheral vascular disease (PVD) which is present in 30% of foot ulcers 2
• Presence of foot ulcers, with a 15% lifetime risk in all diabetic patients 2
• Foot deformities and increased skin pressure due to neuropathy 4

Risk Factors and Complications

The examination may also reveal:

• Peripheral neuropathy, which is present in 33% of patients with diabetes 5
• Peripheral vascular disease, which is present in 25% of patients with diabetes 5
• Potentially unsafe nail and foot care practices 5
• Increased risk of amputation, with a rate 17-40 times higher than in non-diabetics 2
• High mortality rates associated with diabetic foot ulcers, with 5% mortality in the first 12 months and 42% in 5 years 6

Assessment and Treatment

The diabetic foot examination is a key component in the care of patients with diabetes, and includes:

• Annual assessment for patients with diabetes, with more frequent assessments for those with risk factors 3
• Foot care education and treatment, including debridement, antibiotics, and revascularization 2, 6
• Referral to a multidisciplinary diabetic foot wound clinic for comprehensive care 6
• Use of adjuvant therapies to improve wound healing rates and reduce amputation rates 6