Cavanagh et al recommend a rapid examination of the feet for all diabetics that should be performed at least once a year. This can help identify a patient at increased risk for foot problems. The authors are from Pennsylvania State University and the Cleveland Clinic.

A person who has lost protective sensation will continue with an injurious activity because s/he does not experience pain. Some sensation may still be present and the person may not be aware of the sensory loss unless specifically tested.


A person is considered to be at high risk for diabetic foot problems if one or more of the following is present:

(1) there is a history of or evidence for a previous diabetic foot problem (ulceration, blisters, amputation, debridements, vascular procedures, etc.)

(2) no palpable pulse in both the posterior tibial artery (behind the medial maleolus) and the dorsalis pedis (on the dorsum of the foot).

(3) there is a loss of protective sensation at one or more sites


A person is considered to be at low risk if:

(1) there is no history of or evidence for a diabetic foot problem

(2) one or both pulses are palpable

(3) protective sensation is present at all sites


Protective sensation refers to a level of sensation sufficient for a person to experience pain when injured. It is measured with a 10 gram monofilament:

(1) over the plantar surface of the forefoot

(2) include the toes and metatarsal heads

(3) avoid callused areas


A patient at high risk for diabetic foot problems should have a more detailed foot examination.

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