DIABETIC FOOT ASSESSMENT

🦶 DIABETIC FOOT ASSESSMENT: Inlow’s 60-Second Screen

📝 Step 1: Assess the Foot Check BOTH feet for:

1. Self-Reported Risk Factors (ask the patient)

• Retinopathy 👁

• Cardiovascular disease ❤

• Nephropathy 🩸

• Peripheral arterial disease (PAD) 🚫💉

• Poor glycemic control 📈

• Smoking 🚬

2. Foot + Nail Changes

• Skin:

  • Intact? Dry? Fungus (Athlete’s foot)? Callus?

  • Macerated toe webs? Ulcers?

• Nails:

  • Well-trimmed or thick/yellow/damaged? (Onychomycosis = fungal)

3. Loss of Protective Sensation (LOPS)

• Ask: Do your feet ever feel numb, tingly, burn, or like insects crawling? 🐜🔥

• Perform 10-point monofilament test

  • Eyes closed, random order, press until filament bends into C-shape

4. Peripheral Arterial Disease (PAD)

• Ask about pain when walking (claudication)

• Check for:

  • Dependent rubor (redness that fades with elevation)

  • Cool foot (cold compared to other)

  • Pedal pulses:

    • Dorsalis pedis (top of foot)

    • Posterior tibial (inside ankle)

5. Foot Deformities + Footwear

• Bunion, hammertoes, Charcot foot (rocker-bottom), dropped metatarsals

• Hallux (big toe) ROM: normal, limited, or rigid?

• Footwear: supportive? causing trauma?

📝 Step 2: Determine Risk for Ulceration/Amputation (Use results to determine risk category: Very Low → Urgent)

📝 Step 3: Create Care Plan Tailor based on risk and findings.

⚠ COMPLICATIONS TO KNOW

1. Peripheral Neuropathy

• Damaged nerves → no pain/temp sensation → ulcers

• Also causes motor issues → muscle wasting → deformities

2. Peripheral Arterial Disease (PAD)

• Narrow arteries → poor blood flow → ischemia

• Can cause:

  • Pain/cramps when walking (claudication)

  • Chronic limb-threatening ischemia: ulcers, gangrene

3. Ulcers & Infections

• Often preceded by calluses or trauma

• Can become polymicrobial (staph, gram-neg, anaerobes)

• Risk of:

  • Cellulitis

  • Deep infections

  • Osteomyelitis

  • Amputation 😱

💬 COUNSELLING POINTS: What to Say to Patients

🧼 Daily Foot Care:

• Wash and dry feet daily (esp. between toes)

• Lotion for dry skin (NOT between toes)

• Inspect feet every day (use mirror if needed)

• Cut toenails straight across

• Wear clean socks + good shoes 👟

• Check bath water with hand — avoid burns!

• Never walk barefoot 🚫🦶

❌ What to Avoid:

• OTC corn/wart removers

• Soaking feet or very hot baths

• Tight socks/clothing

• Heaters/hot water bottles on feet

📅 When to Seek Help:

• Any cuts, ulcers, redness, warmth, swelling, or pain

• Corns, calluses, ingrown nails — see foot care specialist

📆 Follow-Up Frequency