The Critical Role of Foot Examination in Diabetic Patients

Somerset Family Medicine SFM Blog The Critical Role of Foot Examination in Diabetic Patients

Diabetes mellitus, a chronic metabolic disorder, can lead to a variety of complications that affect multiple organ systems. Among these complications, diabetic foot problems are among the most concerning, often leading to disability and, in severe cases, amputations. Early detection and proactive management of foot-related issues in diabetic patients are critical in preventing these outcomes. This article explores the importance of routine foot examinations and the role they play in maintaining the health and quality of life of diabetic individuals.

Diabetes affects the body in multiple ways, primarily through poor blood sugar control, which leads to:

These factors significantly raise the risk of foot complications, such as ulcers, infections, and, in extreme cases, amputations. Regular foot examinations are essential to detect early signs of complications before they become more severe.

A thorough foot examination involves inspecting both feet for any signs of problems and testing sensory and circulatory function.

The lack of sensation in the feet due to diabetic neuropathy means patients may not feel injuries or wounds. Regular foot exams can detect any loss of sensation, allowing for prompt intervention. Simple tests, such as the monofilament test, can be performed to assess sensation and detect early signs of neuropathy.

Reduced blood flow to the feet can lead to tissue damage and slow wound healing. During a foot exam, healthcare providers will check for signs of poor circulation, such as cold feet, hair loss, and changes in skin color. Doppler ultrasound and ankle-brachial index (ABI) tests can help assess circulation in more detail. Foot exams can help detect ulcers at an early stage, potentially preventing severe complications like gangrene. Regularly checking the feet for cuts, redness, or abnormal swelling is vital.

Diabetic patients may develop foot deformities, such as Charcot foot, where bones in the foot collapse due to nerve damage. Deformities can lead to abnormal pressure points, increasing the risk of ulcers. Regular assessments can identify changes in foot structure and provide an opportunity to correct abnormal gait or suggest the use of custom footwear.

Recommended Guidelines for Foot Examination

Frequency: Diabetic patients should have a comprehensive foot exam at least once a year. However, patients with previous foot complications or those with severe neuropathy may need more frequent assessments.

Self-Examination: Patients should be encouraged to inspect their feet daily for any cuts, blisters, redness, or swelling. A mirror can be helpful for those with limited mobility or who cannot see the bottom of their feet.

Healthcare Provider’s Role:  Physicians and diabetes care teams should regularly perform thorough foot exams, including checking for:

Skin integrity (looking for blisters, calluses, or wounds).

Circulatory health (checking pulses and skin temperature).

Nerve function (assessing sensation and reflexes).

Structural deformities (looking for changes in shape or alignment of the feet).

 

Along with regular examinations, proper foot care is essential in managing diabetes and preventing complications. Some tips include:

Proper Footwear: Diabetic patients should wear shoes that fit well and offer ample support. Custom orthotics may be necessary for those with foot deformities.

Moisturizing: Dry, cracked skin increases the risk of infection, so patients should moisturize their feet regularly while avoiding lotion between the toes.

Good Hygiene: Regularly wash feet with mild soap and warm water, and ensure they are dried thoroughly, especially between the toes.

Nail Care: Trim toenails straight across to avoid ingrown nails

Avoid Walking Barefoot: Patients should avoid walking barefoot, even indoors, to prevent injuries.

Foot examinations are a cornerstone of diabetes management. Regular screening can identify early signs of complications that, if addressed promptly, can prevent serious issues such as infections, ulcers, and amputations. By making foot care a priority, both healthcare providers and diabetic patients can help preserve mobility, quality of life, and long-term health.

References

 https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/foot-problems

Diabetes Care 2024;47(Suppl. 1):S231–S243 | https://doi.org/10.2337/dc24-S012

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