Annual Diabetes Foot Exam Performing LEAP Exam Lower

Annual Diabetes Foot Exam Performing LEAP Exam (Lower Extremity Amputation Prevention )

Comprehensive Foot Exam • Instructions • Use copies of the annual foot exam form to document findings. A trained health care worker should conduct the foot exam. Prepare the patient for the examination by removing his/her shoes and socks/hose.

Level One LEAP Foot Screen (Comprehensive Foot Exam) Diabetes Foot Screen Name (Last, First, MI) ____________________________Date: ______ Fill in the following blanks with a "Y" or "N" to indicate findings in the right or left foot. R L Is there a history of a foot ulcer? _________ Is there a foot ulcer now? _________ Is there a claw toe deformity? _________ Is there swelling or an abnormal foot shape? _________ Is there elevated skin temperature? ________ Is there limited ankle dorsiflexion_________ Are the toenails long, thick or ingrown? _________ Is there heavy callous build-up? _________ Is there foot or ankle muscle weakness? _________ Is there a pedal pulse? _________ Can the patient see the bottom of their feet? _________ Are the shoes appropriate in style and fit? _________ Note the level of sensation in the circles: (+) = Can feel the 5. 07 filament (-) = Can't feel the 5. 07 filament Left Right Skin Conditions on the Foot or Between the Toes: Draw in: Callous, Pre-ulcer, Ulcer (note length and width in cm) Label with: R - redness, M - maceration, D - dryness, T - Tinea RISK CATEGORY: ____ 0 No loss of protective sensation. ____ 1 Loss of protective sensation ____ 2 Loss of protective sensation with either high pressure (callous/deformity), or poor circulation. ____ 3 History of plantar ulceration, neuropathic fracture (Charcot foot) or amputation Performed by _________________

Comprehensive Foot Exam I. Presence of Diabetes Complications- Complete the questions as directed. II. Current History- Complete the questions as directed. III. Foot Exam- Complete the questions or fill in the items as directed. IV. Item 1. Condition of the skin, hair and toenails Item 2: Musculoskeletal Deformities Item 3: Pedal Pulses Item 4: Sensory Exam Risk Categorization

Presence of Diabetes Complications Question : Does the patient have any history of the macro- and microvascular complications of diabetes, a previous amputation, or a previous foot ulcer? Patients who have been diagnosed with peripheral neuropathy, nephropathy, retinopathy, peripheral vascular disease or cardiovascular disease are likely to have had diabetes for several years and to be at risk for diabetes foot problems. A positive history of a previous amputation places the patient permanently in the high risk category. Specify the type and date of amputation(s). Patients with a history of foot ulcer are more likely to develop another one.

Comprehensive Foot Exam II. Current History Complete the questions as directed.

Current History Question : Does the patient have a foot ulcer now?

Comprehensive Foot Exam III. Visual Foot Exam

Visual Foot Exam • Current clinical recommendations call for visual inspection of the feet: • At every visit for people who have neuropathy. • At least twice a year for people with one or more high risk* foot conditions to screen for the development of additional risk factors. • At least annually, or more often if warranted, for low risk feet. *

Visual Foot Exam 1. Inspect the foot between the toes and from toe to heel. Examine the skin for injury, calluses, blisters, fissure, ulcers, or any unusual condition. 2. Look for thin, fragile, shiny, and hairless skin — all signs of decreased vascular supply. 3. Feel the feet for excessive warmth and dryness.

Visual Foot Exam 4. Remove any nail polish. Inspect nails for thickening, ingrown corners, length, and fungal infection.

Visual Foot Exam 5. Inspect socks or hose for blood or other discharge. 6. Examine footwear for torn linings, foreign objects, breathable materials, abnormal wear patterns, and proper fit.

Visual Foot Exam 7. If any new foot abnormality is found, the patient should be scheduled immediately for a comprehensive foot examination.

Comprehensive Foot Exam • • Perform the monofilament exam using a 5. 07/10 gram Filament. Touch the patient’s foot (in each of the designated areas) using enough pressure to cause the filament to bend slightly. • Record a (+) if the patient can feel the pressure and a (–) if the patient does not feel the pressure. +

Level One LEAP Foot Screen (Comprehensive Foot Exam) Diabetes Foot Screen Name (Last, First, MI) ____________________________Date: ______ Fill in the following blanks with a "Y" or "N" to indicate findings in the right or left foot. R L RLIs there a history of a foot ulcer? _________ Is there a foot ulcer now? _________ Is there a claw toe deformity? _________ Is there swelling or an abnormal foot shape? _________ Is there elevated skin temperature? ________ Is there limited ankle dorsiflexion_________ Are the toenails long, thick or ingrown? _________ Is there heavy callous build-up? _________ Is there foot or ankle muscle weakness? _________ Is there an absent pedal pulse? _________ Can the patient see the bottom of their feet? _________ Are the shoes appropriate in style and fit? _________ Note the level of sensation in the circles: + = Can feel the 5. 07 filament- = Can't feel the 5. 07 filament Left Right Skin Conditions on the Foot or Between the Toes: Draw in: Callous, Pre-ulcer, Ulcer (note length and width in cm) Label with: R - redness, M - maceration, D - dryness, T - Tinea RISK CATEGORY: ____ 0 No loss of protective sensation. ____ 1 Loss of protective sensation ____ 2 Loss of protective sensation with either high pressure (callous/deformity), or poor circulation. ____ 3 History of plantar ulceration, neuropathic fracture (Charcot foot) or amputation Performed by _________________

Comprehensive Foot Exam IV. Risk Categorization Based on the foot exam, determine the patient’s risk category. A definition of “low risk” or “high risk” for recurrent ulceration and ultimately, amputation, is provided in the following chart, along with minimum suggested management guidelines. Individuals who are identified as high risk may require a more comprehensive evaluation.

Comprehensive Foot Exam *RISK CATEGORY: ____ 0 No loss of protective sensation. ____ 1 Loss of protective sensation ____ 2 Loss of protective sensation with either high pressure (callous/deformity), or poor circulation. ____ 3 History of plantar ulceration, neuropathic fracture (Charcot foot) or amputation

Comprehensive Foot Exam 8. Document findings on the “Level One Leap Foot Screen” form and in the chronic disease area (39) of the medical record.

Comprehensive Foot Exam • If you have any questions about the foot exams, please feel free to speak with Laura Pryor or any member of the Health Disparities Collaborative (HDC)Team.