Preventive Foot Care in Diabetes
- American Diabetes Association
Foot ulcers and amputations are a major cause of morbidity, disability, as well as emotional and physical costs for people with diabetes. Early recognition and management of independent risk factors for ulcers and amputations can prevent or delay the onset of adverse outcomes. This position statement provides recommendations for people who currently have no foot ulcers, and outlines the best means to identify and manage risk factors before a foot ulcer occurs or an amputation becomes imminent. These recommendations are based on the technical review of care for the nonulcerated foot in diabetes (1). An American Diabetes Association consensus statement covers the management of diabetic foot wounds (2).
RISK IDENTIFICATION
Risk identification is fundamental for effective preventive management of the foot in people with diabetes. The risk of ulcers or amputations is increased in people who have had diabetes ≥10 years, are male, have poor glucose control, or have cardiovascular, retinal, or renal complications. The following foot-related risk conditions are associated with an increased risk of amputation:
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Peripheral neuropathy with loss of protective sensation
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Altered biomechanics (in the presence of neuropathy)
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Evidence of increased pressure (erythema, hemorrhage under a callus)
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Bony deformity
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Peripheral vascular disease (decreased or absent pedal pulses)
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A history of ulcers or amputation
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Severe nail pathology.
FOOT EXAM
All individuals with diabetes should receive an annual foot examination to identify high-risk foot conditions. …
