Rec­om­men­da­tions

11.32 Per­form a com­pre­hen­sive foot eval­u­a­tion at least an­nu­al­ly to iden­tify risk fac­tors for ul­cers and am­pu­ta­tions. B

11.33 Pa­tients with ev­i­dence of, sen­so­ry loss or prior ul­cer­a­tion or am­pu­ta­tion should have their feet in­spect­ed at every visit. C

11.34 Ob­tain a prior his­to­ry of ul­cer­a­tion, am­pu­ta­tion, Char­cot foot, an­gio­plas­ty or vas­cu­lar surgery, cigarette smok­ing, retinopa­thy, and renal dis­ease and as­sess cur­rent symp­toms of neu­ropa­thy (pain, burn­ing, numb­ness) and vas­cu­lar dis­ease (leg fa­tigue, clau­di­ca­tion). B

11.35 The ex­am­i­na­tion should in­clude in­spec­tion of the skin, as­sessment of foot de­for­mi­ties, neu­ro­log­i­cal as­sessment (10-g monofilament test­ing with at least one other as­sessment: pin­prick, tem­per­a­ture, vi­bra­tion), and vas­cu­lar as­sessment in­clud­ing puls­es in the legs and feet. B

11.36 Pa­tients with symp­toms of clau­di­ca­tion or de­creased or ab­sent pedal puls­es should be re­ferred for ankle-‍brachial index and for fur­ther vas­cu­lar as­sessment as ap­pro­pri­ate. C

11.37 A mul­ti­dis­ci­plinary ap­proach is rec­om­mend­ed for in­di­vid­u­als with foot ul­cers and high-‍risk feet (e.g., dial­y­sis pa­tients and those with Char­cot foot or prior ul­cers or am­pu­ta­tion). B

11.38 Refer pa­tients who smoke or who have his­to­ries of prior lower-‍ex­trem­i­ty com­pli­ca­tions, loss of pro­tec­tive sen­sa­tion, struc­tural abnor­malities, or pe­riph­er­al ar­te­ri­al dis­ease to foot care spe­cialists for on­go­ing pre­ventive care and life­long surveil­lance. C

11.39 Pro­vide gen­er­al pre­ventive foot self-‍care ed­u­ca­tion to all pa­tients with di­a­betes.  B

11.40 The use of specialized therapeutic footwear is recommended for high-risk patients with diabetes including those with severe neuropathy, foot deformities, or history of amputation. B