Foot Exam Instructions

Visual Foot Inspection

Objectives

• Quickly identify an obvious foot problem.

• Document foot inspection findings.

• Determine the need for a comprehensive foot exam.

• Schedule follow-up care and referrals.

Instructions

A physician, nurse, or other trained staff may complete this inspection.

1. Inspect the foot between the toes and from toe to heel. Examine the skin for injury, calluses, blisters, fissure, ulcers, or any unusual condition.

2. Look for thin, fragile, shiny, and hairless skin—all signs of decreased vascular supply.

3. Feel the feet for excessive warmth and dryness.

4. Remove any nail polish. Inspect nails for thickening, ingrown corners, length, and fungal infection.

5. Inspect socks or hose for blood or other discharge.

6. Examine footwear for torn linings, foreign objects, breathable materials, abnormal wear patterns, and proper fit.

7. If any new foot abnormality is found, the patient should be scheduled immediately for a comprehensive foot examination.

8. Document findings in the medical record.

Frequency of Inspection

Current clinical recommendations1 call for visual inspection of the feet:

• At every visit for people who have neuropathy.

• At least twice a year for people with one or more high risk* foot conditions to screen for the development of additional risk factors.

• At least annually, or more often if warranted, for low risk feet.*

In populations where the prevalence and incidence of diabetes foot problems are high, providers may determine that inspection of the feet at every visit — for both low and high risk patients — is warranted. To facilitate foot inspection and examination, consider adopting a policy such as “For all patients with diabetes, remove shoes and socks in preparation for examination.”

*Refer to chart for definitions of risk.

¹ American Diabetes Association: Clinical Practice Recommendations 2000. Diabetes Care 2000:23(Suppl.1); S55-56.

National Diabetes Education Program (NDEP)    http://ndep.nih.gov
NIDDK, National Institutes of Health, Bethesda, MD

A Joint Initiative of the National Institutes of Health and the
Centers for Disease Control and Prevention