What A Comprehensive Foot Exam Assesses
A diabetes foot ulcer prevention and management plan begins with proper wound management guidelines and a comprehensive foot exam. The American Diabetes Association (ADA) strongly recommends that ALL diabetes patients have a comprehensive foot exam at least annually in their primary care setting. This exam assesses for neuropathy (sensory, motor, and autonomic), arterial insufficiency, musculo-skeletal abnormalities, skin health and patient hygiene/self-care, and gait issues. A problem with any of these elements may later necessitate a Lower Extremity Amputation (LEA), but the highest risk factors are:
Loss of protective sensation (LOPS)
Prior history of foot wound or amputation
Elevated plantar pressure
Decreased flexibility of the ankle and toes
While the primary care provider is responsible for completing the foot exam, it is important for the patient to take a proactive role in their patient-provider relationship by requesting that the exam be provided (if not provided already). Based upon the results of the foot exam, patients are stratified into risk categories and a corresponding wound management guidelines are devised.
Prevention Program for High Risk Patients
Patients in the high risk category for developing a diabetes foot ulcer may benefit from enrollment in a Lower Extremity Amputation Prevention Program (LEAP). LEAP includes 5 major prevention interventions:
1.) foot screening
2.) patient education
3.) appropriate footwear selection
4.) daily foot inspection by the patient
5.) Management of simple foot problems (to prevent deterioration into more significant problems)
As described above, it is common for patients with diabetes to have loss of sensation in their feet. Pain typically serves as the body’s natural warning sign of injury, but due to this sensory loss diabetics do not experience pain and are often unaware that they have a foot ulcer. Prior to the formation of a foot wound, the skin becomes inflamed. The earliest signs of inflammation can be measured using an infrared dermal thermometer before visual detection by the patient or care provider. Current evidence and proper wound management guidelines strongly support the use of an infrared thermometer as a home monitoring tool, so that high-risk patients can identify inflammation and take actions to prevent the formation of an ulcer.
How Can Corstrata Assist Providers and Payers with High Risk Diabetic Foot Patients?
Corstrata has developed a Diabetes Foot Ulcer Prevention Program (LEAP) that incorporates wound management guidelines and the home surveillance of dermal foot temperatures. Utilizing the principles of motivational interviewing and behavior modification, Corstrata wound specialists work with patients to equip them with the skills for self-management.
Additionally, Corstrata offers a four hour continuing education program on “Current Trends in the Assessment and Management of Diabetes Foot Wounds.” This continuing education program provides clinical staff with a strong, evidence based wound management guidelines and a foundation regarding caring for patients who have diabetes related foot wounds. Emphasis is placed on key components of a comprehensive foot exam, including guidelines for performing a bedside ankle-brachial index (ABI) exam and the interpretation of ABI values. Discussion regarding etiology and risk factors that lead to Diabetes related amputation is provided. An extensive overview of peripheral neuropathy in diabetes is discussed. Specific strategies regarding foot offloading, topical therapy and dermal temperature surveillance are presented. These strategies address both wound management and amputation prevention efforts.