Perspectives

Prioritising assessment of ‘at-risk’ feet in diabetes: individualising foot care

Sarah McCosker, Thyra Bolton, Stephen M Twigg

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Abstract

All patients with diabetes should have their feet assessed to determine their level of risk for foot complications. Foot care and education should be individualised accordingly.

Key Points

  • One of the most cost-effective practices any health professional can perform in patients with diabetes is to examine their feet with their shoes removed.
  • The risk of foot ulceration is doubled in patients with diabetes who also have peripheral neuropathy or peripheral arterial disease (PAD).
  • Actively screening patients with diabetes for loss of protective sensation of the feet is of utmost importance as it often occurs without symptoms.
  • Although peripheral neuropathy is the leading risk factor for foot ulceration, a pivotal event such as trauma from footwear will often precipitate the ulceration.
  • In the assessment of PAD it is important to ask patients about symptoms of intermittent claudication or rest pain; however, those who have dense peripheral neuropathy and/or immobility are unlikely to report such symptoms.
  • General foot care advice should be provided to all people with diabetes but foot care education should be tailored to the individual’s risk of complications.

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