By Dr. Mitchell Waskin
November 07, 2013
Category: Diabetic Foot Care
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Patients often ask me, what's involved in an annual comprehensive diabetic foot exam? Actually, it's a very simple, comfortable and painless exam to have done. 


We start by looking at your medical history: what other problems do you have besides diabetes? We look at the medications you're taking, because some medications can mimic certain symptoms of diabetes. We want to know what your allergies are. Beyond that, it becomes more of a basic exam …


For example, we look at your circulation. We feel the pulses in your feet, to see how good they are. If we have any problem feeling the pulses, we have specialized equipment that can, in much more detail, determine the circulation down to your feet. 


We want to look at the skin and the nails, to see if there are any problems indicating either a local issue going on in your feet, or a more systemic problem that's going on with your diabetes. We want to look even at just the nails — how thick are they? Sometimes patients will get thick nails, and in a diabetic patient, that can cause a sore to form under the nail. Are the nails ingrowing? Maybe there's a little infection from the ingrowing nail. Maybe that's not a big problem in someone without diabetes, but in diabetic patients, a small infection can become a big problem very quickly. 


We want to see how good the feeling is in your feet. We look at things like the ankle reflexes. You've probably had a reflex test before, perhaps during a physical at your primary care doctor's office. We want to look to see if you have that reflex. Because, when you lose that reflex, it's one of the earliest indicators of nerve damage. 


We check your temperature sensation. Can you feel cold, from the tops and bottoms of your feet? When you lose temperature sensation, that's also an indicator of some damage to the nerves. 


We use a tool called a monofilament to test the sensation in your feet. It's very soft, and it doesn't hurt. But it's set at a certain pressure, and if you can feel it, then you have enough sensation to know if you're causing damage to your feet. We can check by touching the monofilament to different areas of your feet to see if you can or can't feel it. 


One of the earliest indicators of nerve damage is vibratory sensation. When you have your physical with your primary care physician, they might take a tuning fork and touch it to your foot. Well, that's good, but it's not really that accurate. We use something called a biothesiometer, which we can adjust to measure how much vibration you feel, so we can actually quantify the level of nerve function that you have. Again, it's completely painless. We touch the device to your toe, and as we adjust it, you just tell us when you can or cannot feel it anymore. 


We look at deformities in your foot. Do you have any bunions, or hammer toes (toes that bend up)? These are areas that can rub in your shoe and become points of infection. These are also places where ulcers might form. And ulcers are serious in diabetics, because 15 percent of diabetic patients who get an ulcer will go on to have an amputation of their leg — which is what we're ultimately trying to prevent. 


As you can see, a comprehensive diabetic foot exam a very simple examination, completely painless, and it takes about 20 - 30 minutes. If you have diabetes, making sure you get this exam every year is one of the most important things you can do to manage your diabetes and prevent amputations. 


For more information or to schedule your diabetic foot exam, give us a call at 804-320-FOOT (804-320-3668), or check out the links below. Please help us spread the word about this simple but lifesaving exam — If you know someone who has diabetes, please share this post with them using the social sharing icons at the bottom of this page.