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Comprehensive DFU evaluation

An important first step in treating patients with diabetic foot ulcers (DFUs) is conducting a thorough evaluation of the wound bed.

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Annual foot screening
Follow-up is important

Annual foot screening

A thorough, annual foot examination is recommended for all patients with diabetes. Patients with risk factors, such as neuropathy, a history of ulcers, vascular disease, or foot deformities, should be monitored more frequently. If patients have sensory loss, they should receive podiatric care and education regarding preventive foot care. They should also wear shoes with adequate depth and width to prevent trauma.

comprehensive foot exam

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Follow Up

Follow-up is important1,2

  • All patients with diabetes must have their feet evaluated at yearly intervals for factors that predispose them to ulceration and amputation
  • If abnormalities are present, more frequent evaluation is recommended
  • Based on the examination, patients should be assigned a foot risk category and corresponding treatment and follow-up

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  1. Boulton AJM, Armstrong DG, Albert SF, et al. Comprehensive foot examination and risk assessment. A report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care. 2008;31(8):1679-1685.
  2. American Diabetes Association. Preventive foot care in diabetes. Diabetes Care. 2004;27(suppl 1):S63-S65.
  3. Reiber GE, Ledoux WR. Epidemiology of diabetic foot ulcers and amputations: evidence for prevention. In: Williams R, Herman W, Kinmonth AL, Wareham NJ, eds. The Evidence Base for Diabetes Care. West Sussex, England: John Wiley & Sons, Ltd.;2002:641-665.
  4. Reiber GE, Boyko EJ, Smith DG. Lower extremity foot ulcers and amputations in diabetes. In: Bowker JH, Pfeifer MA, eds. Levin and O'Neal's The Diabetic Foot. 6th ed. Philadelphia, PA: Mosby Elsevier;2011:409-428.
  5. Young MJ, Boulton AJM, Macleod AF, Williams DRR, Sonksen PH. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia. 1993;36:150-154.
  6. Boulton AJM, Kirsner RS, Vileikyte L. Neuropathic diabetic foot ulcers. N Engl J Med. 2004;351:48-55.
  7. Gordois A, Scuffham P, Shearer A, Oglesby A, Tobian JA. The health care costs of diabetic peripheral neuropathy in the U.S. Diabetes Care. 2003;26(6):1790-1795.
  8. Ramsey SD, Newton K, Blough D, et al. Incidence, outcomes, and cost of foot ulcers in patients with diabetes. Diabetes Care. 1999;22(3):382-387.
  9. Department of Labor Statistics. CPI detailed report. Data for November 2008.
  10. Margolis DJ, Malay DS, Hoffstad OJ, et al. Economic burden of diabetic foot ulcers and amputations. Diabetic Foot Ulcers. Data Points #3 (prepared by the University of Pennsylvania DEcIDE Center, under Contract No. HHSA290200500411). Rockville, MD: Agency for Healthcare Research and Quality. January 2011. AHRQ Publication No. 10(11)-EHC009-2-EF.
  11. Steed DL, Attinger C, Colaizzi T, et al. Guidelines for the treatment of diabetic ulcers. Wound Rep Regen. 2006;14:680-692.
  12. Rooke TW, Hirsch AT, Misra S, et al. 2011 ACCF/AHA focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline): A report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. Circulation. 2011;124:2020-2045.
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