DM Full Guideline (2010) - VA/DoD Clinical Practice Guidelines Home

Version 4.0
ALGORITHM
VA/DoD Clinical Practice Guideline
for the Management of Diabetes Mellitus
1 Person with DM
and no foot evaluation
within one year
Management of Diabetes Mellitus
Module F - Foot Care
F
Page 1
2
Perform and document visual
inspection of feet
[ A ]
3
Perform foot risk assessment:
1. Assess for protective sensation
2. Assess for lower extremity vascular disease
3. Evaluate for foot deformities and skin integrity
4. Prior history of foot ulcer or amputation?
[ B ]
4 Are any of the following present?
- Systemic infection
- Acute ischemia or rest pain
- Foot ulceration
- Puncture wound
- Ingrown toenail
- Hemorrhagic callus with or without
cellulitis
[ C ]
Y
5
Refer to appropriate level of care for
evaluation and treatment
[ D ]
N
6
Is patient at high-risk
for a foot problem?
[ E ]
Y
7
Is there a minor wound
or lesion?
[ F ]
8
Y
Refer to foot care specialist
for evaluation and treatment
[ G ]
N
N
9
Confirm follow-up by foot care
specialist if indicated
and compliance by patient
12
Is there a minor
wound or lesion?
[ F ]
N
Y
Go to
page F2
10
Perform and document patient
education
for preventive foot care and footwear
[ H ]
11
Perform visual inspection and peripheral
sensation evaluation at each routine
primary care visit
[ I ]
Continue DM management
Return to Module D
Jan-03
Module F – Foot Care Page 95