Screening

Screening for foot complications in patients with diabetes should be done at least once yearly.​[22][23][53]​​​ The screening exam identifies risk factors and may help reduce the risk of limb loss.[22] At-risk individuals should be assessed at each visit and should be referred to foot care specialists for ongoing preventive care and surveillance.[22]

See Diagnosis approach (Physical exam) for advice on how to perform a comprehensive foot examination in people with diabetes.

Physical exam should be used to stratify people into risk categories, to reflect their risk of developing foot ulcers and determine the frequency of ongoing foot checks. The following risk stratification system has been developed by the International Working Group on the Diabetic Foot, and is recommended by the American Diabetes Association:[22][23]

Category 0 (very low risk):

  • No loss of protective sensation (LOPS) and no peripheral arterial disease (PAD)

Annual foot screening and examination

Category 1 (low risk):

  • LOPS or PAD

Foot screening and examination once every 6-12 months

Category 2 (moderate risk):

  • LOPS + PAD

  • LOPS + foot deformity

  • PAD + foot deformity

Foot screening and examination once every 3-6 months

Category 3 (high risk):

  • LOPS or PAD, and one or more of the following:

    • History of a foot ulcer

    • A lower extremity amputation (minor or major)

    • End-stage renal disease

Foot screening and examination once every 1-3 months

LOPS is defined as a reduction in sensation or proprioception, as assessed using a 10 g monofilament, the Ipswich Touch Test, tuning fork or biothesiometer/neurothesiometer. The IWGDF definition of ‘foot deformity’ includes any limitation in foot or ankle movement. Please see History and exam for the full list of deformities.

Patients with diabetic foot ulcers are at especially high risk of malnutrition. It is recommended that healthcare providers develop and implement a formalized nutrition screening and assessment protocol to help identify patients with or at risk of malnutrition. A number of validated screening tools are available, e.g., Nutritional Risk Index (NRI), Malnutrition Universal Screening Tool (MUST) and Mini Nutritional Assessment (MNA).[54] Choice of screening tool depends on the population and available resources. If initial screening suggests an increased risk for malnutrition, the next step should be a thorough nutrition assessment, e.g., Patient-Centered Subjective Global Assessment (PC-SGA) or Nutrition Focused Physical Assessment (NFPA).[54]​ 

Use of this content is subject to our disclaimer