Diabetes Mellitus Algorithm F: Foot Care

Person with DM and no foot evaluation within one year
Perform and document visual inspection of feet [A]
Perform foot risk assessment: 1. Assess for protective sensation 2. Assess for lower extremity vascular disease 3. Evaluate for foot deformities and skin integrity 4. Prior history of foot ulcer or amputation? [B]
Are any of the following present: Systemic infection. Acute ischemia or rest pain. Foot ulceration. Puncture wound. Ingrown toenail. Hemorrhagic callus with or without cellulitis [C] Box 4 yes to box 5 Refer to appropriate level of care for evaluation and treatment [D]
Is patient at high risk for a foot problem? [E] Is there a minor wound or lesion? [F] Refer to foot care specialist for evaluation and treatment [G]
Box 6 no to box 12 Box 7 no to box 9 Confirm follow-up by foot-care specialist if indicated and compliance by patient
Is there a minor wound or lesion? [F] Continue with Box 13 Perform and document patient education for preventive foot care and footwear [H]
Box 12 no to Module D Perform visual inspection and peripheral sensation evaluation at each routine primary care visit [I]
Continue DM management. Return to Module D.
Continue from Box 12
Person with DM and minor wounds or foot lesion and no high risk factors
Perform wound assessment [J]
Is this a minor lesion? [F] Provide local wound care. Offload pressure and weight as indicated [K]
Box 15 no to box 22 Has wound healed within 4 weeks? [L] Boxes 17, 18, 23, and 25 to box 19
Refer to foot care specialist for wound care treatment [G]
Is this a minor foot problem? [M] Treat as appropriate [N]
Does patient need nail or callus care? Treat as appropriate. Consider referral to podiatrist
Box 24 no to box 19 Confirm follow-up by foot care specialist if indicated and compliance by patient
Perform and document patient education for preventive foot care and footwear [H]
Perform visual inspection and evaluate peripheral sensation at each routine primary care visit [I]
Continue DM management. Return to Module D