Comprehensive Foot Examination

History and Assessment for Risk Factors
• History of diabetes
• Previous ulcerations, amputations, or nonhealing wounds
• Charcot joint or other foot deformities
• Vascular surgery (stents or bypass) or angioplasty
• Cigarette smoking
Neuropathic symptoms:
• Burning or shooting pain, electrical or sharp sensations
• Numbness or altered sensation (i.e., feeling dead or missing)
Vascular symptoms:
• Claudication, pain associated with movement, or pain at rest
Other complications from diabetes:
• History of nephropathy or retinopathy
• Ongoing podiatry involvement
• Skin status: color, thickness, dryness, and cracking
• Sweating
• Infection: check nails and between the toes for fungal infections
• Ulceration
• Calluses or blistering, with or without bleeding
• Deformity (e.g., hammer toe, Charcot joint)
• Muscle wasting (wrinkling between metatarsals)
Neurological Assessment
• 10-g monofilament test
• Vibration using 128-Hz tuning fork
• Pinprick sensation
• Ankle reflexes
• Vibration perception threshold
Vascular Assessment
• Foot pulses
• Ankle-brachial index test, if indicated