DIABETIC FOOT ASSESSMENT

A brief outline of a simple foot assessment

Cameron Kippen

In the Beginning

The longer we live the more we seem to rely on the services of others to tend to our feet.

The Podiatric Demographic

Seniors, Sight challenged Hypertensive Peripheral vascular

disease Varicosities Water retention Arthritides Diabetes Obesity Other co-moribidity

Complications of the Diabetic Foot

Ischaemia

Deformity

Infection

Ulceration

Charcot’s neuroarthropathy

Assessing Diabetic Peripheral Neuropathy

• Monofilaments 5.07 (10g)

• Neuropathy Disability Score

• Vibration Perception

• Pin Prick Sensation

• Temperature Sensation

• Propriception

• Ankle Reflex

Semes-Weinstein Monofilaments 5.07 (10g)

Modified Disability Score

Vibration Perception Threshold

Pin prick test Proprioception

Achilles Tendon Reflex

Sensorimotor Symptoms

Muscle Wastage Joint Mobility

Vascular Status

Pulses

Diagnostic Ultrasound

Ankle Brachial Pressure Index

Toe Index.

Foot Morphology & Locomotion

Symmetry

Pivot points and Pressure areas

Amputation

Muscle wastage

Abnormal gait patterns

Footwear Assessment

Size (length and breadth)

Volume

Suitability

Wear marks

Category of Risk

Low risk i.e. no risk factors with palpable pulses and normal sensation. Recommend annual foot examination and education.

Intermediate risk i.e. the presence of neuropathy or absent pulses or foot deformity . Recommend review every 3 to 6 months.

High risk i.e. where two or more risk factors are present (neuropathy, peripheral arterial disease or foot deformity or a previous history of foot ulceration . Recommend 3 to 6 months reviews.

Critical risk Referral GP/Hospital within 24 hours

CARE

Control Blood Glucose Levels

Annual Foot Screening Examination

Report change immediately

Engage in simple daily foot care

Collaborative Approach

Team Care Arrangements –item 723

General Management Plan – 721

Enhanced Primary Care Plan

Community Aids and Equipment Program (CAEP)

References

National Evidence-Based Guideline Prevention, Identification and Management of Foot Complications in Diabetes April 2011

http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/diabetes_foot_full_guideline_23062011.pdf Australasian Podiatry Councilhttp://www.apodc.com.au/ Diabetes Australiahttp://www.diabetesaustralia.com.au/

Commonwealth of Australia

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