Proper foot care is vital to overall health, particularly for those with diabetes. Up to 25% of people with diabetes will develop a foot complication in their lifetime, making them a major cause of morbidity, mortality, and increased healthcare costs. A comprehensive foot exam is one of the best ways to prevent, identify, and treat small problems before they become large complications. You should see your healthcare provider annually, or more frequently if you are considered high-risk, for a comprehensive foot exam.
Your foot exam will consist of three major components:
- health history
- physical examination
- special testing
Your foot exam may take place on its own, or as a part of a larger, overall health checkup, like an annual physical. Below is a thorough explanation of each component, with key elements to discuss with your healthcare provider.
Overall Health History
The first part of your comprehensive foot exam will be a discussion of your overall health, including diabetes management and any general concerns or complications. Your healthcare provider may inquire about your activity level, diet, and lifestyle, as it relates to your overall and foot health. Be sure to bring up any concerns you may have or changes you have noticed in your feet during this segment.
Your healthcare provider will ask a variety of questions such as:
- Have you had any pain or discomfort?
- Do you have any numbness or tingling?
- Have you ever had a cut or blister that was slow to heal?
- How are you managing your diabetes? What was your last A1C?
Be sure to be honest and open about any changes or concerns you have. There is no concern too small to discuss at your annual foot exam.
Physical Examination of Feet and Legs
Next, your healthcare provider will examine your feet, without shoes or socks. Generally, this hands-on assessment will include an overall inspection of your feet, including the skin, nails, joint ranges of motion, and foot function. Your healthcare provider may move your feet around, ask you to perform simple movements, watch you walk, or observe your feet and legs from different perspectives. If you are seeing a foot specialist for your foot exam, they may also examine your shoes and observe you walking and standing.
The observations noted during the physical exam will help your healthcare provider determine your risk of complications and make recommendations on steps to prevent or treat any issues that arise.
If you have noticed a change in the way your feet feel, move or function, be sure to mention it to your healthcare provider during your assessment.
The final component of a foot exam usually incorporates special tools or testing protocols to check the neurological (nerve) and vascular (blood flow) states of your feet and legs. Over time, Diabetes can have a significant impact on the function of both your nerves and blood vessels, making it imperative to incorporate this component into your regular foot exam.
Neurological (nerve) testing can be performed using a monofilament, tuning fork or other tools to test your sensation. The monofilament is the most common, as it is also the most reliable. A monofilament is a short, thin plastic filament that is pressed against your skin to assess sensation.
Before commencing the test, your healthcare provider will have you remove your shoes and socks and position your feet so the soles are facing them. They may demonstrate how the monofilament works on your hand or wrist so that you know the sensation you are being asked to identify. You will then be asked to relax, avert your eyes and identify where on your foot you are feeling the monofilament. Your healthcare provider will assess several sites on each foot, recording how many sites are correctly detected.
A tuning fork, cotton wool or other tools may also be used as an alternative means of testing sensation. Any impairments noted during this assessment will help to formulate your treatment plan, as well as to decide how often you should have an assessment.
Vascular (blood flow) assessment is another essential component of special testing during your annual foot exam. A combination of visual and hands-on techniques will be utilized to assess both the arterial (blood flow in) and venous (blood flow out) status of your feet.
Visual Assessment of Feet and Legs
You can also expect a visual assessment of your feet and lower legs during your annual foot exam. This will include looking for changes in veins, skin, swelling, hair growth, and nail condition. Changes in any of these areas can be an indication of a vascular problem. Your healthcare provider may also ask if your feet feel unusually hot or cold, or if you experience any swelling.
Analysis of Pedal Pulses and Capillary Refill
Pedal pulses and capillary refill are two key indicators of vascular health in the feet and lower legs. Your healthcare provider will check your pedal pulses on both the top of your foot and behind the inside of your ankle. They will also check your capillary refill. This is performed by gently squeezing or pressing on a toe until the skin is blanched (turns white). The toe is then released, and your healthcare provider will count the number of seconds it takes to turn pink once again.
How Often Should I Have a Foot Exam?
The frequency of a foot exam is generally determined by the level of risk. For people with low risk, an annual foot exam is typically sufficient. For those with a moderate risk, an assessment every 3-6 months may be recommended. For those with a history of foot complications, or a higher risk of developing a complication, having a foot exam every 1-3 months is usually recommended to closely monitor any changes and prevent complications as best as possible.
Who Do I See for a Foot Exam?
Your family doctor, nurse practitioner, diabetes care team, or foot specialist can perform your foot exam on a schedule that suits your needs. They will also be able to inform you, based on the findings on your foot exam, on how to best care for your feet, what preventative measures to take, and when you should return for follow up.
Looking for more information regarding foot examinations and what to expect? We can help! Contact us today to book an appointment with one of our expert Pedorthists.