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The statistics are staggering, and do not include those 57 million Americans with prediabetes. Amputations are common and may include a toe, foot or leg and are frequently followed by amputations on the contra lateral side. Amputation is a predictor of mortality. Mortality rates increase as the level of amputation progresses more proximally, with each subsequent amputation, and with advanced age. 65% of all people who experience an amputation related to diabetes die within 5 years. Diabetic foot ulcers affect roughly 15% of all people with diabetes and ulceration precedes amputation in 85% of the amputations that occur annually. The National Institute of Health reports that comprehensive foot care programs can reduce amputation rates by 45 to 85%. This would seem a simple enough issue to diagnose, yet the problem remains, as to convincing clinicians to take the extra step and ask their patients to take off their shoes and socks in order to get a look at their feet. Education on foot care, consistent quality assessment, early intervention and accessible health care are necessary to reverse these grim findings and save limbs. Foot Assessment Let’s take a look at foot assessment. Like all patient assessments, a foot assessment should begin by first creating rapport with the patient in order to make it easier to obtain a thorough and comprehensive history. It can be useful to conduct the patient history while they still have their shoes and socks on, while watching them walk. Once the formal history taking is complete and the patient has been made aware of what will take place during the physical exam, it can be a good idea to have them take their shoes and socks off and roll up their pants/skirt above the knee. The key to getting an accurate history, then, is asking the right questions. Before looking at the patient’s feet, gather some baseline information. Things like how long they have had diabetes, what self-care management strategies they use, and at what frequencies. Also find out what meds they are on and have them talk about their meals. Ask about other chronic health issues that may be impacting their health. What do they do for a living? Do they smoke-how much and how long? Alcohol or other drug use? Who do they see to help them manage their diabetes? Has diabetes caused them any problems with their kidneys, eyes or feet (or anything else)? Do they provide their own foot care? Have they had any foot problems? Do they have an ulcer now or have they had one in the past? If you have a patient who has a “problem” make sure you compare your findings in both extremities.
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