Comprehensive Foot Exam
Pt presents in Office for a for a comprehensive foot exam with [textarea name="variable_1" default="sample text"] history of: • previous leg/foot ulcer or lower limb amputation/surgery? • prior angioplasty, stent, or leg bypass surgery? • foot wound requiring more than 3 weeks to heal? • smoking or nicotine use? • diabetes? (If yes, what are the patient’s current control measures?) Does the patient have: • burning or tingling in legs or feet? • leg or foot pain with activity or at rest? • changes in skin color, or skin lesions? • loss of lower extremity sensation? Has the patient established regular podiatric care? Dermatologic exam: • Does the patient have discolored, ingrown, or elongated nails? • Are there signs of fungal infection? • Does the patient have discolored and/or hypertrophic skin lesions, calluses, or corns? • Does the patient have open wounds or fissures? • Does the patient have interdigital maceration? Neurologic exam: • Is the patient responsive to the Ipswich Touch Test? Musculoskeletal exam: • Does the patient have full range of motion of the joints? • Does the patient have obvious deformities? If yes, for how long? • Is the midfoot hot, red, or inflamed? Vascular exam: • Is the hair growth on the foot dorsum or lower limb decreased? • Are the dorsalis pedis and posterior tibial pulses palpable? • Is there a temperature difference between the calves and feet, or between the left and right foot? Education: Recommendations for daily foot care: • Visually examine both feet, including soles and between toes. If the patient can't do this, have a family member do it. • Keep feet dry by regularly changing shoes and socks; dry feet after baths or exercise. • Report any new lesions, discolorations, or swelling to a health care professional. Education regarding shoes: • Educate the patient on the risks of walking barefoot, even when indoors. • R ecommend appropriate footwear and advise against shoes that are too small, tight, or rub against a particular area of the foot. • Suggest yearly replacement of shoes—more frequently if they exhibit high wear. Overall health risk management: • Recommend smoking cessation (if applicable). • Recommend appropriate glycemic control.
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