Diabetes Foot Screen - Hrsa Page 3

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Question 10: Can the patient see the bottom of his/her feet?
Obesity and/or lack of flexibility can prevent a patient from seeing his/her feet.
Self-inspection and foot care is difficult with these limitations often requiring
family or outside assistance.
Question 11: Is the patient wearing improperly fitted shoes?
An improperly fitted shoe may create foot pressures that lead to further
complications. Patients with sensory loss often wear shoes that are too short
and/or narrow resulting in ischemic ulcers on the medial or lateral metatarsal
heads or the toes of a foot with claw toe deformity. Properly sized added depth
shoes with soft custom molded insoles are usually indicated for patients with loss
of sensation and deformity to prevent ulceration.
Question 12: Does the patient use footwear appropriate for his/her
category?
See risk and management categories.
Section 2:
Examine the foot and record problems identified on the Foot Screen form. Draw
calluses, pre-ulcerative lesions (a closed lesion i.e. blister or hematoma) or open
ulcers as accurately as possible using the appropriate "pattern" to indicate what
type of condition is present. Label areas that are red "R", warm "W" (warmer than
the other parts of the foot or the opposite foot), dry "D" or macerated "M" (friable,
moist, soft tissue) on the corresponding location of the foot drawing provided on
the screen form.
A sensory exam using the 10 gram monofilament is performed at the indicated
on the foot drawing. Responses are recorded in the appropriate circles. A
positive response is recorded in the corresponding circle with a "+" if the patient
is able to feel the filament and a negative response is recorded with a "-" if the
patient cannot feel the filament.
Section 3:
The accurate placement of patients into their respective Risk Category is a key
element in the Foot Screen. The higher the Risk Category, the higher the risk a
patient has of recurrent foot ulceration, progressive deformity, and ultimately,
amputation of the foot. All patients, regardless of category, should be re-
screened annually and should be given basic patient education.
A detailed description of the Risk Category is available in the document “Risk
and Management Categories for the Foot.”

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