The 3-Minute Diabetic Foot Exam

People with type 2 diabetes are at risk of lower extremity amputation that stems from nerve damage and circulation issues. Reduced blood flow to the lower extremities means that people are at higher risk of developing a wound. If the person also has neuropathy, they may be less likely to notice wounds or ulcers before they become severe.

Every 1.2 seconds, someone develops a diabetic foot ulcer. Every 20 seconds, someone with an ulcer undergoes an amputation. Most of these amputations are preventable with proper screenings and care. A simple, 3-minute foot exam helps care providers quickly detect significant risk factors, prompting referral to appropriate specialists.

 

Did You Know?

Although this diabetic foot exam is quick, it can be life-changing and life-saving. Here are the facts:

  • 37% of diabetes patients who suffer a lower extremity amputation will undergo another amputation within five years.⁶

  • More than 80% of amputations begin with non-healing foot ulcers.²

  • Up to 50% of people who endure an amputation due to diabetes will die within two years.⁵

Remember, just three minutes can save a life.

 

How to Perform the Exam

The exam is divided into three parts: what to ask, what to look for and what to teach. Each part of the exam should be completed in about one minute.

 

Minute 1: What to Ask

During the first minute of the exam, focus on the patient’s health history, current symptoms and history of podiatric care. Ask the patient if they have any of the following:

Health history

  • Previous lower extremity ulcers, amputations or surgeries

  • Prior angioplasty, stent or leg bypass surgery

  • Foot wounds

  • Smoking or nicotine use

  • Diabetes and current control measures

  • Regular podiatric care

Symptoms

  • Burning or tingling in lower extremities

  • Leg or foot pain with activity

  • Changes in skin color or skin lesions

  • Loss of lower extremity sensation

 

Minute 2: What to Look For

After taking the patient’s history and symptoms, use the second minute to perform the physical exam. Check for the following:

Dermatologic exam

  • Discolored, ingrown or elongated nails

  • Signs of fungal infection

  • Discolored and/or hypertrophic skin lesions, calluses or corns

  • Open wounds or fissures

  • Interdigital maceration

Neurologic exam

  • Response to light touch on the feet (protective sensation)

Musculoskeletal exam

  • Full range of motion of the joints

  • Obvious deformities

  • Hot, red or inflamed skin on the midfoot

Vascular exam

  • Decreased hair growth on foot dorsum or lower limb

  • Palpability of pulse on the dorsalis pedis and posterior tibial pulse sites

 

Minute 3: What to Teach

During the final minute of the exam, educate the patient about caring for their lower extremities and managing their overall health. Discuss the following recommendations:

Daily foot care

  • The patient or a family member should check both feet, including the sole and between the toes.

  • Keep feet dry; change socks and shoes regularly, and dry feet after bathing or exercise.

  • Report any changes in appearance, including new lesions, discolorations or swelling, to a healthcare professional.

Shoes

  • Avoid walking barefoot, even when indoors.

  • Wear appropriate footwear. Do not wear shoes that are too small or tight, or rub against a particular area of the foot.

  • Replace shoes yearly or more frequently if they show high wear.

Overall health risk management

  • Smoking cessation

  • Appropriate glycemic control

 

Treatment and Follow-Up

After performing the 3-minute foot exam, take action based on the patient’s risk level. No matter their risk, all patients with diabetes should see a foot specialist at least once a year.

 

Urgent (Active Pathology)

An immediate referral to a specialist is indicated if the patient has any of the following:

  • Open wound, with or without signs of infection

  • New neuropathic pain or pain at rest

  • Signs of active Charcot deformity (red, hot, swollen midfoot or ankle)

  • Vascular compromise, including the sudden absence of dorsalis pedis/posterior tibial pulses or gangrene

 

High Risk (ADA Risk Category 3)

The patient should be referred to a specialist immediately or for the next available outpatient appointment if the following symptoms are present:

  • Presence of diabetes with a history of ulcer or lower extremity amputation

  • Chronic venous insufficiency (skin color change or temperature difference)

The patient should follow up with the specialist every 1-2 months.

 

Moderate Risk (ADA Risk Category 2)

For patients with moderate risk, refer to a specialist within 1-3 weeks if not already receiving regular care. Indications of moderate risk are:

  • Peripheral artery disease with or without Loss of Protective Sensation (LOPS)

  • Dorsalis pedis or posterior tibial pulse diminished or absent

  • Presence of swelling or edema

The patient should follow up with a specialist every 2-3 months.

 

Low Risk (ADA Risk Category 1)

A low-risk patient should be referred to a specialist within one month. The following symptoms indicate low risk:

  • LOPS with or without longstanding, nonchanging deformity

  • The need for prescriptive or accommodative footwear

The patient should follow up with a specialist every 4-6 months.

 

Very Low Risk (ADA Risk Category 0)

Very low-risk patients should visit a specialist within 1-3 months. Very low risk is indicated by:

  • No LOPS or peripheral artery disease

  • A patient who is engaged in their care and seeks information about foot care, athletic training, appropriate footwear, etc.

The patient should follow up with a specialist at least annually.

Performing a 3-minute foot exam is a simple way you can take a stand for diabetic foot health. To you, it’s only three minutes. To your patient, it could be their whole life.