Leese et al reported a scheme for identifying the risk of foot lesions in a diabetic. This can help identify a patient who may require closer monitoring and preventive interventions. The authors are from the University of Dundee, Ninewells Medical School, Westgate Health Centre, Kings Cross Hospital and Perth Royal Infirmary in Scotland.
Parameters:
(1) palpable pulses in each foot (in one or both of the dorsalis pedis and posterior tibial arteries; absent pulses is defined as the absence of both pulses in either the left or right foot)
(2) history of diabetic ulceration or amputation
(3) ability to feel a 10 gram monofilament at 5 plantar sites (great toe, first metatarsal head, second metatarsal head, third metatarsal head, fifth metatarsal head; neuropathy was defined as an inability to detect the monofilament at 2 or more of the 10 sites on both feet with the monofilament pushed until it bent)
(4) foot deformity (change in foot shape that resulted in being difficult to fit with standard shoes) and/or callus
(5) ability to see the feet
(6) ability to reach the feet (absence of physical disability that prevented the person from being able to reach the feet)
NOTE: The criteria are based on evaluation of both feet. Although the absent pulses may be in the left foot and the neuropathy in the right the overall risk is increased.
Low risk - all of the following:
(1) able to detect at least 1 pulse per foot
(2) able to feel the 10 g monofilament (absence of neuropathy)
(3) absence of foot deformity and callus
(4) absence of visual impairment
(5) absence of physical deformity preventing the person from reaching the feet
(6) no history of previous foot ulceration or amputation
High risk - one or more of the following:
(1) history of previous foot ulceration or amputation
(2) absent pulses AND inability to feel the monofilament at 2 or more sites (presence of diabetic neuropathy)
(3) absent pulses AND presence of foot deformity or callus
(4) inability to feel the monofilaments at 2 or more sites AND presence of foot deformity or callus
Moderate risk: not classified as low or high risk
