Diabetes foot exams

Last foot exam was:
Consent was obtained and the procedure explained. Adequate exposure of entire legs was done.
Visual inspection: Gen inspection reveals no missing limb, toes. Normal limb color (no erythema or pallor). On close examination, no hair loss (e.g. from PVD) or skin changes. No dryness/erythema. No venous or arterial ulcers. No joint deformities (Charcot’s disease). Inspection between toes, plantar surface, and heels is also normal.
Palpation: Normal cap refill. Normal DP/PT pulses.
10g Monofilament testing:
Vibration using 128-Hz tuning fork: Normal.
Ankle reflex:
Proprioception:
Gait: Normal – smooth and symmetrical.
Footwear inspection: Normal even soles.

The patient doesn’t use any walking aids.

Patient informed that this exam needs to happen once a year.

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An acceptable exam is defined as follows.
Definition:
“Lower Extremity Neurological Exam – Consists of a documented evaluation of motor and sensory abilities
and should include: 10-g monofilament plus testing any one of the following: vibration using 128-Hz tuning
fork, pinprick sensation, ankle reflexes, or vibration perception threshold), however, the clinician should
perform all necessary tests to make the proper evaluation.”

“RATIONALE:
Foot ulceration is the most common single precursor to lower extremity amputations among persons with diabetes.
Treatment of infected foot wounds accounts for up to one-quarter of all inpatient hospital admissions for people with
diabetes in the United States. Peripheral sensory neuropathy in the absence of perceived trauma is the primary
factor leading to diabetic foot ulcerations. Approximately 45-60% of all diabetic ulcerations are purely neuropathic.
Other forms of neuropathy may also play a role in foot ulcerations. Motor neuropathy resulting in anterior crural
muscle atrophy or intrinsic muscle wasting can lead to foot deformities such as foot drop, equinus, and hammertoes.
In people with diabetes, 22.8% have foot problems – such as amputations and numbness – compared with 10% of
nondiabetics. Over the age of 40 years old, 30% of people with diabetes have loss of sensation in their feet.”

Table 1 – Risk Categorization System

From: https://www.apta.org/uploadedFiles/APTAorg/Payment/Medicare/Pay_for_Performance/PQRS/2016/2016_PQRS_Measure_126.pdf

References

Am Fam Physician. 2016 Nov 15;94(10):834-835. http://www.aafp.org/afp/2016/1115/p834.html

http://www.aafp.org/journals/fpm/blogs/gettingpaid/entry/diabetes_foot_exams_among_changes.html