Foot problems are an important cause of morbidity in
diabetes mellitus. vascular and neurologic disease
contribute to this problem.
15% of patients with type 1 and type 2
diabetes will develop one or more foot
ulcerations in their lifetime

Assessment of risk factors
 Diabetic peripheral neuropathy
 Peripheral vascular disease
 Skin condition
 Foot deformity
 Footware
Facts
Amputation rates are 15 –
40 times higher for diabetic
than non-diabetic patients .
Assessment of Risk Factors
Diabetic peripheral neuropathy
Peripheral vascular disease
Skin condition
Foot deformity
Footware
DETECTING FEET-AT-RISK
Prior LEA
Prior foot ulcer
Known PAD or claudication < 1 block
Major foot deformities
Pre-ulcer cutaneous pathology
Insensate to 5.07/10g monofilament
PAD
Screening
 All patients with diabetes should be screened at regular
intervals to identify those at risk for foot ulceration
Foot ULCER RISKS
Decrease adherence to self-foot care
Emotional maladaptive responses
Depression, anxiety
Cognitive dysfunction
Decrease self-foot care
– Can’t see feet (retinopathy)
Not access to foot care centers
Visual Inspection
Colour of Skin
Trauma/Ulceration
Callus
Swelling
Nail deformities
Signs of pressure
General hygiene/self care
FOOT DEFORMITIES
Hammer toes
Claw toes
Prominent metatarsal heads
Hallux valgus
Collapsed plantar arch
Neuropathy
Neuropathy promotes ulcer formation by
decreasing pain sensation and perception
of pressure, by causing muscle imbalance
that can lead to anatomic deformities and
by impairing the microcirculation and the
integrity of the skin.
Symptom of Neuropathy
 What is the sensation felt ?
burning, numbness, or tingling (2 points); fatigue, cramping, or
aching (1 point). Maximum is 2 points
 What is the location of symptoms ?
feet (2 points); calves (1 point); elsewhere (no points). Maximum is 2
points.
 Have the symptoms ever awaken you at night ?
yes (1 point).
Symptom of Neuropathy
What is the timing of symptoms ?
worse at night (2 points); present day and night
(1 points); present only during the day (no
points). Maximum is 2 points.
How are symptoms relieved ?
walking around (2 points); standing (1 point);
sitting or lying or no relief (no points).
Maximum is 2 points.
Diabetic symptoms score
0 to 2 — normal
3 to 4 — mild
5 to 6 — moderate
7 to 9 — severe
Neuropathy Sign
 What is the Achilles tendon reflex ?
absent (2 points for each foot); present with reinforcement (1 point
for each foot).
 What is the vibration sense ?
absent or reduced (1 point for each foot).
 What is the pinprick sensation ?
absent or reduced (1 point for each foot).
 What is the temperature sensation ?

reduced (1 point for each foot).
Neuropathy Sign
0 to 2 — normal
3 to 5 — mild
6 to 8 — moderate
9 to 10 — sever
Neuropathy
Peripheral neuropathy is considered to be present if
there are moderate or severe signs (6 or more) even in
the absence of symptoms.
Mild signs (3 to 5) in the presence of moderate
symptoms.
 A neurologic signs score of 8 or more is indicative of
a high-risk foot.