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National Diabetes Education Program
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Tools for Diabetes Foot Exams


The following section provides tools to help you and your staff incorporate diabetes foot exams into clinical practice and improve patient outcomes. Research indicates that when tools like these are used by providers, more examinations of lower extremities are performed, patients at risk for amputation are identified, and more patients are referred for podiatric care.1 Using these tools also will help providers meet the Healthy People 2010 Diabetes Objectives that include increasing the proportion of persons with diabetes who have at least an annual foot examination and reducing the frequency of foot ulcers and lower extremity amputations in persons with diabetes.

Current clinical recommendations call for a comprehensive foot examination at least once a year for all people with diabetes to identify high risk foot conditions. People with one or more high risk foot conditions should be evaluated more frequently for the development of additional risk factors. People with neuropathy should have a visual inspection of their feet at every contact with a health care provider.2

In communities where the prevalence and incidence of diabetes foot problems are high, providers may determine that inspecting feet at every visit – for both low and high risk patients – is warranted.

The following tools will help you incorporate diabetes foot exams into your practice.

Flow Chart for Diabetes Foot Exams – depicts the desired sequence of exams for patients with low-risk or high-risk feet.

Diabetes Foot Exam Procedures – explains the recommended procedures for conducting comprehensive foot examinations and visual inspections.

Quality of Care Measures – specifies ways in which documented foot care practices can be audited to indicate short, intermediate, and long-term outcomes. These outcomes can be used by providers to improve diabetes foot care performance.

Foot Exam Instructions – provides step-by-step instructions for completing a visual inspection of the feet and an annual comprehensive foot exam.

Annual Comprehensive Diabetes Foot Exam Form – documents inspection of skin, hair, and nails, examination of musculoskeletal structures, pedal pulses, and protective sensation, assessment of risk for foot problems, assessment of footwear, and completing a management plan.

See “Additional Tools” for these items:

High Risk Feet Stickers – designed for creating brightly colored “high risk” feet stickers on Avery labels to place on the medical record.

Examination Room Flyers (English and Spanish) – encourage patients to re m ove shoes and socks in p reparation for a foot exam.


1 Litzelman DK, Slemenda CW, Langefeld, CD, et al. Reduction of lower extremity clinical abnormalities in patients with non-insulin-dependent diabetes mellitus. Annals of Internal Medicine 119(1):36-41, 1993.

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


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National Diabetes Education Program (NDEP)    http://ndep.nih.gov
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Centers for Disease Control and Prevention