Diabetic Foot Screening and Risk Stratification

Core Screening Components

The American Diabetes Association recommends a 10-g monofilament test combined with at least one additional neurological assessment, inspection of the skin, and palpation of pedal pulses for all diabetic patients at least annually 1, 2
The 10-g Semmes-Weinstein monofilament test is the single most useful test to diagnose loss of protective sensation (LOPS), which is present in 78% of diabetic patients who develop foot ulcers 3
Combining the monofilament test with one additional test from pinprick sensation, temperature perception, vibration with 128-Hz tuning fork, or ankle reflexes is recommended 1, 2, 3
Absent monofilament sensation confirms LOPS, while at least two normal tests (with no abnormal tests) rules it out 1, 2

Palpation of dorsalis pedis and posterior tibial pulses in both feet is recommended 1, 2, 3
The American Diabetes Association suggests asking about leg fatigue, claudication, and rest pain relieved with dependency 3
Assessment of capillary refill time, rubor on dependency, pallor on elevation, and venous filling time is also recommended 3
Ankle-brachial index (ABI) testing should only be performed if the patient has symptoms or signs of peripheral arterial disease (PAD) on initial screening 1, 2, 3

Inspection of skin integrity for ulcers, calluses, erythema, warmth, or breaks in skin is essential 1, 2
Assessment for foot deformities, including bunions, hammertoes, prominent metatarsal heads, and Charcot foot, is also crucial 1, 3

The American Diabetes Association recommends asking about prior foot ulcers or amputations, neuropathic symptoms, vascular symptoms, visual impairment, renal disease status, tobacco use, and current foot care practices 1, 2

The International Working Group on the Diabetic Foot system should be used to classify patients based on examination findings, with categories ranging from Very Low Risk to High Risk 3
Category 0 (Very Low Risk) patients require annual screening, while Category 1 (Low Risk) patients should be screened every 6-12 months 1
Category 2 (Moderate Risk) patients require screening every 3-6 months, and Category 3 (High Risk) patients should be screened every 1-3 months 1, 3