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Education Material for Health Care Professionals: Newsletter Version


Patients  with HIGH RISK
a) patients who walk barefoot.  
b) patients with diabetic neuropathy.
c) patients with significant peripheral vascular disease.
d) patients who smoke or use tobacco in any form.
e) those with a foot deformity such as claw toes and hallux valgus.
f) diabetics with a history of previous ulcers or foot infections.
g) patients with abnormal gait.
h) those with significant skin and nail infections or deformitoes.
i) blind/partially sighted persons.
j) elderly patients ; especially those living alone,
k) diabetics with chronic renal failure;
l) patients with a high alcohol intake.

The prognosis for the second limb is poor in those who have had an amputation of the contra lateral limb.


A comprehensive foot exam assesses skin, circulation, and sensation. The test can be done during a routine clinic visit


Inspection of the feet of the patient can be one of the most important aspects when screening for diabetic foot problems. In fact, the most important step in the prevention of foot problems is for the doctor to ask the patient to take off their footwear!

The presence of dry or excessively moist, skin, hair and nail abnormalities, corns, calluses, bunions, warts, foot deformities, heel spurs, flat arches, hammer toes, etc., are all pointers to an increased propensity for foot problems.  Occasionally, one may be surprised to find an injury or infections which the patient may have been completely unaware of.

The footwear should also be examined, not only to see if it is appropriate, but often one may find jutting nails which again the patient is unaware of due to the loss of sensations in the feet.


After a detailed history which must include questions about numbness or tingling in the limbs, the most important aspect of grading diabetic neuropathy from foot ulceration point of view is to assess the degree of nerve involvement

The testing is usually done by testing if the patient can feel the pain of a pin prick or the touch of a cotton wool or the vibration of a tuning fork.

Testing with a pin prick Testing with a cotton wool Testing with a tuning fork

These are perfectly useful and time honoured techniques. However, the problems with testing sensation with a pin prick, cotton wool or tuning fork is that every doctor does it in a slightly different way. It is very difficult to standardize the procedures and the results. To overcome these problems, two other methods are often used :

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