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Absent or vague symptoms make foot screening essential for
identifying those at risk [Williams
and Airey, 2000]. Although there is no evidence to indicate
the most effective frequency of screening, the International
Diabetes Federation (IDF) and the International guidelines
on diabetic neuropathy recommend an annual foot examination
for all individuals with diabetes [Boulton
et al, 1998; International Diabetes Federation (European Region),
1999]. This examination should include the assessment
of protective sensation, foot structure and biomechanics,
vascular status and skin integrity especially between the
toes and under the metatarsal heads. Those with neuropathy
should have a visual inspection of their feet at every visit
to a health professional.
Examine:
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Assess:
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foot shape, deformity, joint
rigidity, and shoes.
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history of foot problems since
last review.
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foot skin condition.
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visual and mobility problems
preventing self-care of feet.
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foot and ankle pulses.
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self-care behaviours and knowledge
of foot care.
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sensitivity to monofilament
or vibration, and pin prick.
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Vascular examination should include a visual assessment together
with taking pulses. If further assessment is required, the
patient should be referred for Doppler ultrasound and arteriography
of the leg and foot [Boulton,
1997].
Neurological evaluation should include the use of clinical
neuropathy disability scores, sensory testing with 10-g monofilaments
(e.g. Semmes-Weinstein 5.07-gauge) [American
Diabetes Association, 2002] and/or vibration perception
thresholds to identify patients with neuropathy [Abbott
et al, 1998; Rith-Najarian et al, 1992; Young et al, 1994].
Semmes-Weinstein monofilaments in particular are recommended
as a simple, reproducible and effective screening device
for identifying diabetic patients at risk of foot ulceration
[Kumar et al, 1991; Smieja
et al, 1999].
The presence of erythema, warmth, or callus formation may
indicate areas of tissue damage with impending breakdown.
Moreover, the finding of a unilaterally warm, swollen foot
with palpable pulses should suggest a possible diagnosis of
Charcot neuroarthropathy.
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