TABLE 1.

Comprehensive Foot Examination

History and Assessment for Risk Factors
History: • History of diabetes • Previous ulcerations, amputations, or nonhealing wounds • Charcot joint or other foot deformities • Vascular surgery (stents or bypass) or angioplasty • Cigarette smoking Neuropathic symptoms: • Burning or shooting pain, electrical or sharp sensations • Numbness or altered sensation (i.e., feeling dead or missing) Vascular symptoms: • Claudication, pain associated with movement, or pain at rest Other complications from diabetes: • History of nephropathy or retinopathy • Ongoing podiatry involvement
Inspection
Dermatological: • Skin status: color, thickness, dryness, and cracking • Sweating • Infection: check nails and between the toes for fungal infections • Ulceration • Calluses or blistering, with or without bleeding Musculoskeletal: • Deformity (e.g., hammer toe, Charcot joint) • Muscle wasting (wrinkling between metatarsals)
Neurological Assessment
• 10-g monofilament test • Vibration using 128-Hz tuning fork • Pinprick sensation • Ankle reflexes • Vibration perception threshold
Vascular Assessment
• Foot pulses • Ankle-brachial index test, if indicated