22
Standards of Medical Care
Foot Care
Î The risk of ulcers or amputations is increased in people who have the
following risk factors:
• Previous amputation
• Past foot ulcer history
• Peripheral neuropathy
• Foot deformity
• Peripheral vascular disease
• Visual impairment
• Diabetic nephropathy (especially patients on dialysis)
• Poor glycemic control
• Cigarette smoking
Î For all patients with diabetes, perform an annual comprehensive
foot examination to identify risk factors predictive of ulcers and
amputations.
Note: The foot examination should include inspection, assessment of foot pulses and
testing for loss of protective sensation (10-g monofilament plus testing any one of:
vibration using 128-Hz tuning fork, pinprick sensation, ankle reflexes, or vibration
perception threshold). (B)
ÎProvide general foot self-care education to all patients with diabetes. (B)
Î A multidisciplinary approach is recommended for individuals with foot
ulcers and high-risk feet, especially those with a history of prior ulcer
or amputation. (B)
Î Refer patients who smoke, have loss of protective sensation and
structural abnormalities, or have history of prior lower-extremity
complications to foot care specialists for ongoing preventive care and
life-long surveillance. (C)
Î Initial screening for PAD should include a history for claudication and
an assessment of the pedal pulses.
Note: Consider obtaining an ankle-brachial index (ABI), since many patients with
PAD are asymptomatic. (C)
Î Refer patients with significant claudication or a positive ABI for
further vascular assessment, and consider exercise, medications, and
surgical options. (C)
Diabetes Care in Hospital
Î All patients with diabetes admitted to the hospital should have their
diabetes clearly identified in the medical record. (E)
Î All patients with diabetes should have an order for BG monitoring,
with results available to all members of the health care team. (E)
