It is not my style to knock the advice given by the American Diabetic Association, Podiatrists, the Lower Extremity Amputation Prevention Program or all of those other so-called experts who teach foot exams. I certainly buy into their position that assessing feet is important for so many reasons but I find that their instructions are incomplete. In response, Haydel Consulting Services, LLC has stepped up to the plate to provide you with the missing pieces for a complete foot exam. Pay close attention. The skills you learn could save a limb or a life.
- Start with a foot encased in a shoe and sock. Take a look at the shoe to make sure it is appropriate for the patient and fits well. High heels, flip flops and all the other really cool kinds of shoes are not appropriate for many of our elderly patients. No matter how ugly the shoe is, do not criticize the patient’s choice of footwear if the shoes meet the above criteria.
- Untie the shoe. This may add some time to your visit but it will definitely make it easier to complete the following steps.
- Gently ease the shoe off the foot. Do not pull, tug or otherwise force the shoe off to prevent the foot from coming off with the shoe.
- Inch the sock down from the top towards the toes until the entire foot is visible. DO NOT ATTEMPT STEP 4 UNTIL STEPS 1 – 3 ARE COMPLETE.
- Attentively assess the foot according to the incomplete guidelines published by above referenced agencies. Notice how the nurse in this photo (Susie Soskin, RN) is at eye level with the foot. If you cannot get down to eye level, find someone who can or get the patient to lay down in the bed. If your knees are too old to bend down then chances are your vision is not good enough to assess feet from a distance.
- These are perfect feet. I know this because they belong to my son. I have bought hundreds of shoes for these size elevens. At the cash register, I have often been a bit overwhelmed at the cost of keeping him in shoes. After taking care of a few amputees, I am honored to have had the privilege to buy full pairs of shoes for him. I hope when I am dead and gone, he still has to pay for a full pair.
A high resolution copy of the above tutorial is available by clicking here. Please feel free to print it, share it or ignore it. And yes, I know the vast majority of us do take shoes and socks off every visit and look at diabetic feet. This is good but diabetics are not the only patients who benefit from foot assessments. Patients with heart failure or take diuretics will show signs of fluid build up in their feet, compromised circulation from cardiovascular or other disease can result in discoloration or stasis ulcers and injuries to the feet can be overlooked by any patient with loss of sensation or callused skin.
So, if this helps you to remember, all is well. If you don’t need reminding, kudos to you. If you think that one of your nurses or coworkers is not taking the time to do a complete foot assessment, draw a happy face on the bottom of the foot and see what shows up in the documentation:)
As always, questions and comments are welcome below or via email. As so on…..