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Diabetic Foot Exam

What is a diabetic foot exam?

People with diabetes are at higher risk for a variety of foot health problems. A diabetic foot exam checks people with diabetes for these problems, which include infection, injury, and bone abnormalities. Nerve damage, known as neuropathy, and poor circulation (blood flow) are the most common causes of diabetic foot problems.

Neuropathy can make your feet feel numb or tingly. It can also cause a loss of feeling in your feet. So if you get a foot injury, like a callus or blister, or even a deep sore known as an ulcer, you may not even know it.

Poor circulation in the foot can make it harder for you to fight foot infections and heal from injuries. If you have diabetes and get a foot ulcer or other injury, your body may not be able to heal it fast enough. This can lead to an infection, which can quickly become serious. If a foot infection is not treated right away, it can become so dangerous that your foot may need to be amputated to save your life.

Fortunately, regular diabetic foot exams, as well as home care, can help prevent serious foot health problems.

Other names: comprehensive foot exam

What is it used for?

A diabetic foot exam is used to check for foot health problems in people with diabetes. When ulcers or other foot problems are found and treated early, it can prevent serious complications.

Why do I need a diabetic foot exam?

People with diabetes should get a diabetic foot exam at least once a year. You may need an exam more often if your feet have any of the following symptoms:

  • Tingling
  • Numbness
  • Pain
  • Burning sensation
  • Swelling
  • Pain and difficulty when walking

You should call your health care provider right away if you have any of the following symptoms, which are signs of a serious infection:

  • A blister, cut, or other foot injury that doesn't start to heal after a few days
  • A foot injury that feels warm when you touch it
  • Redness around a foot injury
  • A callus with dried blood inside it
  • An injury that is black and smelly. This is a sign of gangrene, the death of body tissue. If not treated promptly, gangrene can lead to amputation of the foot, or even death.

What happens during a diabetic foot exam?

A diabetic foot exam may be done by your primary care provider and/or a foot doctor, known as a podiatrist. A foot doctor specializes in keeping feet healthy and treating diseases of the feet. The exam usually includes the following:

General assessment. Your provider will:

  • Ask questions about your health history and any previous problems you've had with your feet.
  • Check your shoes for proper fit and ask questions about your other footwear. Shoes that don't fit well or are otherwise uncomfortable can lead to blisters, calluses, and ulcers.

Dermatological assessment. Your provider will:

  • Look for various skin problems, including dryness, cracking, calluses, blisters, and ulcers.
  • Check the toenails for cracks or fungal infection.
  • Check between the toes for signs of a fungal infection.

Neurologic assessments. These are a series of tests that include:

  • Monofilament test. Your provider will brush a soft nylon fiber called a monofilament over your foot and toes to test your foot's sensitivity to touch.
  • Tuning fork and visual perception tests (VPT). Your provider will place a tuning fork or other device against your foot and toes to see if you can feel the vibration it produces.
  • Pinprick test. Your provider will gently poke the bottom of your foot with a small pin to see if you can feel it.
  • Ankle reflexes. Your provider will check your ankle reflexes by tapping on your foot with a small mallet. This is similar to a test you may get at an annual physical, in which your provider taps just below your knee to check your reflexes.

Musculoskeletal assessment. Your provider will:

  • Look for abnormalities in the shape and structure of your foot.

Vascular assessment. If you have symptoms of poor circulation, your provider may:

  • Use a type of imaging technology called Doppler ultrasound to see how well blood is flowing in your foot.

Will I need to do anything to prepare for the test?

You don't need any special preparations for a diabetic foot exam.

Are there any risks to the test?

There are no known risks to having a diabetic foot exam.

What do the results mean?

If a problem is found, your foot doctor or other provider will likely recommend more frequent testing. Other treatments may include:

  • Antibiotics to treat foot infections
  • Surgery to help with bone deformities

There is no treatment for nerve damage to the foot, but there are treatments that can relieve pain and improve function. These include:

  • Medicine
  • Skin creams
  • Physical therapy to help with balance and strength

If you have questions about your results, talk to your health care provider.

Is there anything else I need to know about a diabetic foot exam?

Foot problems are a serious risk to people with diabetes. But you can help keep your feet healthy if you:

  • Take care of your diabetes Work with your health care provider to keep your blood sugar at a healthy level.
  • Get regular diabetic foot exams. You should get your feet checked at least once a year, and more often if you or your provider finds a problem.
  • Check your feet every day. This can help you find and address problems early before they get worse. Look for sores, ulcers, toenail cracks, and other changes in your feet.
  • Wash your feet every day. Use warm water and mild soap. Dry thoroughly.
  • Wear shoes and socks at all times. Make sure your shoes are comfortable and fit well.
  • Trim your toenails regularly. Cut straight across the nail and gently smooth edges with a nail file.
  • Protect your feet from excess heat and cold. Wear shoes on hot surfaces. Don't use heating pads or hot bottles on your feet. Before putting your feet in hot water, test the temperature with your hands. Because of reduced sensation, you can burn your feet without knowing it. To protect your feet from cold, don't go barefoot, wear socks in bed, and in the winter, wear lined, waterproof boots.
  • Keep blood flowing to your feet. Put your feet up when sitting. Wiggle your toes for a few minutes two or three times a day. Stay active, but choose activities that are easy on the feet, such swimming or biking. Talk to your provider before starting an exercise program.
  • Don't smoke. Smoking reduces blood flow to the feet and can make wounds heal slowly. Many diabetics who smoke need amputations.

References

  1. American Diabetes Association [Internet]. Arlington (VA): American Diabetes Association; c1995–2019. Foot Care [updated 2014 Oct 10; cited 2019 Mar 12]; [about 3 screens]. Available from: http://www.diabetes.org/living-with-diabetes/complications/foot-complications/foot-care.html
  2. American Diabetes Association [Internet]. Arlington (VA): American Diabetes Association; c1995–2019. Foot Complications [updated 2018 Nov 19; cited 2019 Mar 12]; [about 3 screens]. Available from: http://www.diabetes.org/living-with-diabetes/complications/foot-complications
  3. Beaver Valley Foot Clinic [Internet]. Podiatrist Near Me Pittsburgh Foot Doctor Pittsburgh PA; c2019. Glossary: Beaver Valley Foot Clinic [cited 2019 Mar 12]; [about 3 screens]. Available from: https://bvfootclinic.com/glossary
  4. Boulton, AJM, Armstrong DG, Albert SF, Frykberg, RG, Hellman R, Kirkman MS, Lavery LA, LeMaster, JW, Mills JL, Mueller MJ, Sheehan P, Wukich DK. Comprehensive Foot Examination and Risk Assessment. Diabetes Care [Internet]. 2008 Aug [cited 2019 Mar 12]; 31(8):1679–1685. Available from: http://care.diabetesjournals.org/content/31/8/1679
  5. Country Foot Care [Internet]. Country Foot Care; 2019. Glossary of Podiatry Terms [cited 2019 Mar 12]; [about 3 screens]. Available from:  https://countryfootcare.com/library/general/glossary-of-podiatry-terms
  6. Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c1998–2019. Diabetic Neuropathy: Diagnosis and treatment; 2018 Sep 7 [cited 2019 Mar 12]; [about 4 screens]. Available from: https://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/diagnosis-treatment/drc-20371587
  7. Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c1998–2019. Diabetic Neuropathy: Symptoms and causes; 2018 Sep 7 [cited 2019 Mar 12]; [about 3 screens]. Available from: https://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/symptoms-causes/syc-20371580
  8. Mishra SC, Chhatbar KC, Kashikar A, Mehndiratta A. Diabetic foot. BMJ [Internet]. 2017 Nov 16 [cited 2019 Mar 12]; 359:j5064. Available from: https://www.bmj.com/content/359/bmj.j5064
  9. National Institute of Diabetes and Digestive and Kidney Diseases [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Diabetes and Foot Problems; 2017 Jan [cited 2019 Mar 12]; [about 5 screens]. Available from: https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/foot-problems
  10. National Institute of Diabetes and Digestive and Kidney Diseases [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Peripheral Neuropathy; 2018 Feb [cited 2019 Mar 12]; [about 6 screens]. Available from: https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies/peripheral-neuropathy
  11. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; c2019. Health Encyclopedia: Special Foot Care for Diabetes [cited 2019 Mar 12]; [about 2 screens]. Available from: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=56&contentid=4029
  12. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2019. Treating Diabetic Foot Problems: Topic Overview [updated 2017 Dec 7; cited 2019 Mar 12]; [about 2 screens]. Available from: https://www.uwhealth.org/health/topic/special/treating-diabetic-foot-problems/uq2713.html

The medical information provided is for informational purposes only, and is not to be used as a substitute for professional medical advice, diagnosis or treatment. Please contact your health care provider with questions you may have regarding medical conditions or the interpretation of test results.

In the event of a medical emergency, call 911 immediately.