Diabetic Foot Exam

People with diabetes have a high risk for many types of foot health problems. A diabetic foot exam can help find problems that can lead to serious infection and amputation (surgery to remove all or part of your foot) if they're not found and treated early.

Diabetic foot problems can happen over time if high blood glucose (blood sugar) damages the nerves and blood vessels in your feet. Nerve damage from diabetes is called diabetic neuropathy. It can make your feet feel numb or tingly. It can also cause you to lose feeling in your feet.

If you don't feel pain in your feet, you may not notice a callus, blister, or cut on your foot. Without treatment, these types of common foot wounds can become ulcers (open sores) that can get infected.

If you have diabetes, a foot sore or infection may not heal well, even with treatment. That's because diabetes can damage blood vessels and cause poor blood flow in your feet. If an infection doesn't get better, tissue in your foot may die. This is called gangrene.

If you have gangrene or an infection that won't heal, your toe, foot, or part of your leg may need to be amputated to prevent infection from spreading and to save your life. Fortunately, you can help keep your feet healthy by:

Getting regular diabetic foot exams
Caring for your feet at home
Keeping your blood sugar within a range that's healthy for you

Other names: comprehensive foot exam

What is it used for?

A diabetic foot exam is used to find foot health problems in people with diabetes before they cause serious infection. The exam is used to check the feet for:

Problems with the nerves and blood flow.
Signs of damage or injury.
Changes in shape. Foot changes, such as bunions and hammer toes (toes that curve upwards with the top part curled under), can make shoes rub and cause foot ulcers.

Why do I need a diabetic foot exam?

People with diabetes usually need to have a complete diabetic foot exam at least once a year to help prevent serious infections. But if you've had foot problems from diabetes, you may need to have a complete foot exam more often.

A complete foot exam may be done by your primary care provider or a foot doctor (podiatrist). A foot doctor specializes in keeping feet healthy and treating foot diseases. Ask the provider you see for foot care to tell you how often you need a complete foot exam.

It's also a good idea to ask your primary care provider to do a quick check of your feet at every health care visit you have during the year. If you're meeting your diabetes treatment goals, your provider will probably want to see you at least twice a year to check your health and review your self-care plan. Make sure to have your feet checked, too.

If you have any of these foot symptoms, contact your provider right away:

A blister, cut, bruise, or other foot injury that doesn't start to heal after a few days.
Skin on your foot that is red, warm, or painful. These are signs of a possible infection.
A callus with dried blood inside it. This may be the first sign of a wound under the callus.
A foot infection that becomes black and smelly. This may be a sign of gangrene.

What happens during a diabetic foot exam?

A complete diabetic foot exam usually includes these steps:

Information about you. Your provider will ask questions about:

Your medical history. This includes how you're managing your diabetes, other conditions you may have, and your symptoms.
The medicines you take.
Your shoes. Your provider may check your shoes for proper fit and ask questions about your other footwear. Shoes that don't fit well can lead to blisters, calluses, and ulcers.

Skin exam. Your provider will check:

The skin of your feet to look for dryness, cracking, calluses, blisters, ulcers, and other damage or abnormal areas
Your toenails for cracks and fungal infection
The temperature of your feet to see if they are the same

Nerve exam. Your provider will do a few tests to check your nerves and the feeling in your feet:

Monofilament test. You will close your eyes while your provider brushes a soft strand of nylon (a monofilament) over your foot and toes. You'll tell your provider when you feel the strand touching your foot.
Tuning fork and vibration perception threshold tests (VPT). Your provider will place a tuning fork or other device that vibrates on different parts of your foot and toes to see if you can feel the vibrations.
Pinprick test. Your provider will gently press a small pin against your big toe to see if you can feel it. The pin will not break through your skin.
Ankle reflexes. Your provider will tap a special, small hammer on your Achilles tendon, the thick band of tissue that connects your calf muscle to your heel bone. If your nerves are working properly, your foot will jerk slightly on its own.

Musculoskeletal (muscle and bone) exam. Your provider will look for problems such as:

Bent or overlapping toes
Bunions
A rocker shape on the bottom of your foot (Charcot Foot)

Vascular (blood vessel) exam. To check blood flow to your feet, your provider may:

Feel the pulses in your foot and ankle
Compare blood pressure measurements in your ankles and arms. If blood pressure in your ankle is lower than in your arm, you may have reduced blood flow to your foot. This is called an ankle-brachial index test. Your provider may do this test if you have signs and symptoms of a blood flow problem.

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?

Your provider will use the results of your exam to estimate your risk of developing foot ulcers and infections that could lead to amputation. If your risk is high, your provider will probably recommend that you have a complete diabetic foot exam more than once a year.

If a problem is found that needs medical care, your treatment will depend on the type of problem and how serious it is. If you have questions about your diabetic foot exam, ask your provider.

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

You can help keep your feet healthy by controlling your blood sugar levels every day and taking good care of your feet. This includes:

Checking your feet every day. Look for cuts, redness, and other changes in the skin and toenails, including warts or other spots that your shoes could rub. Make sure to check the bottoms of your feet too.
Washing your feet every day. Use warm water and soap. Don't soak your feet because that can dry out your skin. After you dry your feet, you can use talcum powder or cornstarch between your toes. They soak up moisture that can cause infection. If you use lotion, don't apply it between your toes.
Asking your doctor how to remove corns and calluses safely. Thick skin on your feet can rub and lead to sores. But removing it the wrong way could damage your skin. So, you don't want to cut the skin or use medicated pads or liquid removers.
Trimming your toenails straight across with a clipper. If it's hard for you to trim your own toenails, or if they're thick or curve into the skin, have a podiatrist (foot doctor) do it for you.
Always wearing well-fitting shoes and socks or slippers to protect your feet when walking. You don't want to walk barefoot, even indoors. And be sure your shoes are smooth inside. A seam or pebble in your shoe could rub your skin raw.
Protecting your feet from heat and cold. Use sunscreen on exposed skin and don't walk barefoot at the beach. In cold weather, wear warm socks instead of warming your feet near a heater or fireplace.
Keeping the blood flowing in your feet. Put your feet up when you're sitting. Wiggle your toes and circle your feet throughout the day. Don't wear tight socks. And get plenty of activity that's not too hard on the feet, such as walking.
Getting your feet checked at your health care visits. Even if you haven't noticed a problem, it's good to have your provider look at your feet.

References

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