As a provider, our job is to help our patients feel comfortable and help them take care of their foot health. One way we help our patients with their foot issues is to get a proper diagnosis and get them in suitable footwear.
Before measuring our patients for their diabetic shoes, it’s essential to assess their feet.
*According to Medicare DMEPOS, when fitting for therapeutic shoes and inserts, an assessment is conducted for the following six reasons:
- To assess the patient’s overall need for the shoes. This includes a comprehensive history, pertinent medical information, and allergies to skin condition diagnosis which is on the patient’s prescription and previous use of shoes.
- To help determine the most appropriate shoes and inserts based on the patient’s need to ensure optimum therapeutic benefits, and proper function as required.
- To formulate a treatment plan consistent with the prescribing physician’s order and consult that physician when necessary.
- To perform a diagnosis-specific clinical examination as related to the patient’s need for the footwear.
- To establish goals and expected outcomes of the patient’s use of the shoes. Examples of the expected results would include reducing pain, increasing comfort, enhancing dependence, or preventing deformities, or promote healing.
- To disclose any potential risks, benefits, and precautions to the physician and the patient.
The primary goal is to assess our patient’s need for the footwear as it relates to the prescription and provide them with the most appropriate shoes and inserts.
Here’s what we include in our assessments for Diabetic Shoe Gear and a comprehensive diabetic foot check.
The foot assessment is conducted in a private room.
Patient’s may have an open wound or fungus on his or her foot. Wearing gloves does not only the patient from infection but also the podiatrist and staff.
Perform on Both Feet
The assessment is conducted on both feet because not all feet are the same. Both feet are assessed to make sure the correct shoes or inserts are recommended.
Start the Assessment
The patient removes his or her shoes and socks, and then roll up their pants, so we have a complete view of the foot and ankle. The shoes worn into the appointment are checked to distinguish gait wear patterns. The insert or orthotic are checked to understand the different wear patterns as well as the length and size.
Biomechanical Side Assessment
The patient is asked to flex their foot and assessed for decreased range of motion. If there’s range of motion difficulties, that would increase plantar or potentially increase plantar pressure.
Plantarflexion and Dorsiflexion Assessment
Here we look at the great toe, also known as the big toe. We then have the patient flex and point the toe to notice the range of motion.
Ankle Adduction and Abduction Assessment
To conduct this assessment, we grab the patient’s heel and the forefoot across the metatarsal heads. Abduction is away from the midline; adduction is towards the midline. We look for any limited range motion.
Inversion and Eversion Assessment
In this assessment, we’re looking for that range of motion or limitations with inversion (toes move inward) and eversion (toes move outward).
In this assessment, we look around the foot and in between the toes for any wounds, ulcers, lesions, corns or abnormalities in the patient’s foot because it could lead to some infection. We also check the patient’s toenails to see if they are properly cut. Toenails should be trimmed straight across, rather than curved. If they are curved, you can be at risk for ingrown toenails.
First, we check the plantar surface temperature of both of the patient’s feet by touch. Warm to the touch or cool to the touch is sufficient and this is performed using gloves.
The next vascular study is to notice if there’s any digital(toe) hair growth. If you have digital hair growth that could indicate good circulation. Loss of digital hair growth could mean a loss of circulation or lack of flow within the foot.
Then, we look for overall color. We pay attention to see if the foot color matches the patient’s leg. We will notice any blues or purples or anything out of the ordinary.
The capillary refill test is relatively simple. With the finger, we apply 2 to 3 seconds of pressure on the patient’s toe and let go for 2 to 3 seconds. Within that timeframe, the color should refill back into the patient’s toe. We assess the length of time it took to refill those capillaries.
We look at the patient’s foot for how the overall texture is. Notice it’s fragile, thin, or shiny—or if there’s severe edema or other issues.
Finally, we do a pulse assessment. There are two pulses that we check on a patient’s foot. One is called the posterior tibial pulse, which is behind the ankle bone called the medial malleolus. And, the other is between the ankle bone and the Achilles tendon. For this assessment, we are checking for the presence or absence.
Megan Rhule PMAC
Site* Dr Comfort