A Podiatry Diabetes Risk Assessment should be carried out at least once a year. Those patients already categorised as high risk will be monitored on a more regular basis.
The assessment will look at these factors:
- Measurement of foot pulses
- Foot temperature check
- Monitoring foot sensation with a 5.07 Weinstein filament
- Vibration perception test
- Skin texture (dryness, maceration)
- Foot and leg skin colour (redness, bruising, blanching etc)
The results will be recorded and the patients risk status for foot problems determined. They will be reassessed and compared at appropriate intervals, relative to the patients risk level. If there is a significant change in any area, the Podiatrist will refer the patient on for appropriate medical attention and or testing. For example if the foot pulses were found to be weaker or not palpable, the patient may be referred on to a vascular specialist for more extensive screening.
- For people already with infection or ulceration, the important thing is to urgently treat the infection and heal the ulcer. It is necessary to distinguish between different types of ulceration, as the treatment required for that in neuropathic or vascular disease may be quite different.
Pain, must also be defined in origin, as vascular or neuropathic because the treatment is again quite different.
- Poor diabetic control increases infection and impairs wound healing. Although it is not possible to be absolutely clear cut, it is generally those with, very poor control (e.g. HbA1c greater than 10%), that is most at risk. Therefore even if diabetic control is not perfect it is worthwhile improving it to a level that is not "very bad". Remember also that even excellent diabetic control by itself will not completely prevent foot problems once severe neuropathy or peripheral vascular disease is established. Preventive and treatment strategies still need to be adhered to.