Have you performed foot examinations ?

Approximately 50% of patients with more than 15 years of diabetes also have peripheral neuropathy. The loss of the protection from sensory nerves often leave people with diabetic unaware of their injuries. The American Diabetes Association recommends that people with diabetic should have annual foot examinations done by medical professionals. Use 128Hz tuning forks, 10g monofilaments, and ankle reflexes to evaluate the protective senses of the foot.

Timing for foot examinations: Initial diagnosis of type 2 diabetes, 5 years after the diagnosis of type 1 diabetes. The main tools used for the foot examination are 128Hz tuning forks, monofilaments, and percussion hammers. The 128Hz tuning fork evaluates the vibration sensation. The monofilament pricks the sole to verify fine sensation perception. If the monofilament bends 45 degrees when pressed against the sole, it is equivalent to 10g of pressure. If 10g of pressure cannot be felt, it is evidence of neuropathy. Studies have shown that the loss of ankle reflexes indicates a higher risk of foot ulcers. Use a percussion hammer to examine ankle reflexes.

When medical profession perform foot examinations, the skin and vessel conditions are also evaluated. Other problems such as skin color, temperature, infections, and wounds are also checked. Palpate the dorsalis pedis and posterior tibial arteries to evaluate the circulation of the foot. This can also be done by the patients themselves at home.  If the results are poor, more foot care is required. “Embers can start wildfires”; a small wound can result in amputation catastrophes. Do not let your guard down.

Reference: American Diabetes Association

                  Joslin Diabetes Center website

                  IDF Clinical Practice Recommendations on the Diabetic Foot – 2017