Diabetic Foot care Recommendations

2016 ADA Guideline Recommendations
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]; Tarek Nafee, M.D. [3]

2016 ADA Standards of Medical Care in Diabetes Guidelines

"1. Perform a comprehensive foot evaluation each year to identify risk factors for ulcers and amputations. (Level of Evidence: B)"

"2. Obtain a prior history of ulceration, amputation, Charcot foot, angioplasty or vascular surgery, cigarette smoking, retinopathy, and renal disease and assess current symptoms of neuropathy (pain, burning, numbness) and vascular disease (leg fatigue, claudication). (Level of Evidence: B)"

"3. The examination should include inspection of the skin, assessment of foot deformities, neurological assessment including 10-g monofilament testing and pinprick or vibration test- ing or assessment of ankle reflexes, and vascular assessment including pulses in the legs and feet. (Level of Evidence: B)"

"4. Patients with a history of ulcers or amputations, foot deformities, insensate feet, and peripheral arterial disease are at substantially increased risk for ulcers and amputations and should have their feet examined at every visit. (Level of Evidence: C)"

"5. Patients with symptoms of claudication or decreased or absent pedal pulses should be referred for ankle-brachial index and for further vascular assessment. (Level of Evidence: C)"

"6. A multidisciplinary approach is recommended for individuals with foot ulcers and high-risk feet (e.g., dialysis patients and those with Charcot foot, prior ulcers, or amputation). (Level of Evidence: B)"

"7. Refer patients who smoke or who have histories of prior lower- extremity complications, loss of protective sensation, structural abnormalities, or peripheral arterial disease to foot care specialists for ongoing preventive care and lifelong surveillance. (Level of Evidence: C)"

"8. Provide general foot self-care education to all patients with diabetes.(Level of Evidence: B)"