Screening
Screening for foot complications in patients with diabetes should be done at least once yearly.[24][25] The screening exam identifies risk factors and may help reduce the risk of limb loss.[24] Patients at higher risk of diabetes-related foot disease should be assessed at each visit, and referred to footcare specialists for ongoing preventive care and surveillance.
The following risk stratification system has been developed by the International Working Group on the Diabetic Foot (IWGDF), and is recommended by the American Diabetes Association:[24][25]
Category 0 (very low risk): annual foot screening and exam
No loss of protective sensation (LOPS) and no peripheral arterial disease (PAD)
Category 1 (low risk): foot screening and exam once every 6-12 months
LOPS or PAD
Category 2 (moderate risk): foot screening and exam once every 3-6 months
LOPS + PAD
LOPS + foot deformity
PAD + foot deformity
Category 3 (high risk): foot screening and exam once every 1-3 months
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
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.
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