FOOT CARE ASSESSMENT IN PATIENTS WITH DIABETES - A SCREENING ALGORITHM FOR PATIENT EDUCATION AND REFERRAL

The foot care behaviors of patients with diabetes were assessed by med ical history, and their feet were examined for peripheral neuropathy, peripheral vascular disease, foot ulcers, and deformities. The sample consisted of 136 patients (14 with insulin-dependent diabetes and 122 with non-insulin-depebdent diabetes). Mean age was 61 years and mean d uration of diabetes was 13 years. Peripheral vascular disease was foun d in 25% of the patients, peripheral neuropathy in 33%, and 13% had bo th peripheral vascular disease and peripheral neuropathy. Potentially unsafe nail and foot care practices were identified, suggesting that r outine diabetes care may not provide sufficient foot care education an d follow-up for all patients. A screening algorithm was developed to p rovide guidelines for individualizing foot care education and referral of patients with diabetic foot disease. The recommendations included annual diabetes foot care assessments and education for those at low r isk for foot amputation, intensive foot care education and more freque nt follow-up for individuals with peripheral neuropathy or peripheral vascular disease, and referral to a foot care specialty clinic for ind ividuals with peripheral neuropathy and peripheral vascular disease, o r foot ulcers.