Diabetes significantly increases the risk of serious foot complications due to nerve damage and poor circulation. High blood sugar levels damage the nerves, causing peripheral neuropathy, which diminishes the ability to feel pain or injury in the feet. Concurrently, diabetes can narrow blood vessels (peripheral artery disease or PAD), slowing blood flow and impairing healing. Because of this dual threat, a minor cut or blister can quickly turn into a non-healing ulcer or infection, making regular professional foot care essential for prevention.
Baseline Frequency for Low-Risk Patients
The minimum recommendation for people with diabetes is a comprehensive diabetic foot screening performed at least once per year by a qualified healthcare professional, such as a podiatrist. This annual assessment serves as the baseline for all diabetic patients, even those who feel their feet are healthy. A patient is classified as “low-risk” if they exhibit no signs of peripheral neuropathy, have good blood circulation, and have no history of foot ulcers or amputations. This standard yearly checkup provides an opportunity for early detection of subtle changes before they progress into a serious complication.
Determining Increased Visit Frequency Based on Risk
The frequency of podiatry visits must increase as a patient’s risk profile elevates beyond the low-risk category. Patients who have established peripheral neuropathy, indicated by a loss of protective sensation, are typically advised to be seen more frequently, often every three to six months. This loss of feeling means a small injury can go unnoticed, necessitating regular professional inspection.
Visits become more condensed—as often as every one to three months—for those with multiple or severe risk factors. Specific factors include peripheral vascular disease (poor circulation), significant foot deformities like Charcot foot, or a history of previous foot ulcers or amputations. For high-risk patients, the goal of more frequent visits is continuous, proactive management to prevent recurrence. These regular appointments allow the podiatrist to identify and immediately address pre-ulcerative lesions, such as excessive callus formation or pressure points.
Components of a Comprehensive Diabetic Foot Exam
A comprehensive diabetic foot exam involves a series of specific assessments designed to evaluate the three primary areas affected by diabetes: nerves, circulation, and skin integrity.
Neurological Assessment
This assessment tests for peripheral neuropathy, most commonly using a 10-gram monofilament. The podiatrist applies this thin nylon filament to specific points on the sole of the foot to check if the patient can feel the pressure, helping to determine the level of protective sensation. A tuning fork may also be used to test vibratory sensation, which is often one of the first sensations lost in neuropathy.
Vascular Assessment
The vascular assessment checks blood flow to the feet, beginning with palpation of the dorsalis pedis and posterior tibial pulses. The strength and presence of these pulses provide immediate insight into the health of the major arteries supplying the foot. If pulses are weak or absent, the podiatrist may suggest further testing, such as an Ankle Brachial Index (ABI), to formally diagnose peripheral artery disease.
Dermatological and Structural Assessment
The dermatological assessment involves a thorough visual inspection of the skin, including the spaces between the toes and the toenails. The podiatrist looks for signs of dryness, cracks, fungal infections, ingrown nails, or any existing blisters, cuts, or sores. A structural assessment evaluates the biomechanics of the foot, checking for deformities like hammertoes or bunions that create abnormal pressure points and lead to ulceration. The fit and condition of the patient’s shoes are also examined, as inappropriate footwear is a frequent cause of injury.
Essential Daily Foot Care and When to Seek Immediate Help
Between professional appointments, the patient’s own daily habits are the first line of defense against complications. This daily care begins with a thorough inspection of both feet, including the tops, soles, and between the toes, using a mirror if necessary to check the bottom. Feet should be washed daily in lukewarm water and dried completely, especially between the toes, to prevent fungal growth.
Moisturizing the skin daily helps prevent cracking, but lotion should never be applied between the toes, as this can encourage moisture retention and infection. Nails should be trimmed straight across to avoid ingrown nails. Patients should always wear well-fitting shoes and seamless socks to minimize friction and pressure. Patients should never walk barefoot, even indoors, to protect against unnoticed injuries.
It is important to know that certain warning signs require immediate medical attention, often within 24 hours. These urgent indicators include any new, unexplained swelling, persistent redness, or warmth in one area of the foot, which can signal an infection or a serious condition like Charcot foot. Any blister, cut, or sore that does not show clear signs of healing within 24 to 48 hours, or any drainage from a wound, must be reported to a podiatrist or primary care physician right away. Changes in skin color, such as pale or bluish patches, or a sudden feeling of burning or tingling can also signal a rapidly worsening problem.