Peripheral neuropathy is often painless, so patients do not report early foot problems. A brief inspection with shoes and socks off, plus a pulse check, takes under two minutes and finds ulcers, callus and deformity before they become infected.
An annual comprehensive foot examination, including monofilament testing, is established practice for people with diabetes. Anyone with loss of sensation, deformity or a previous ulcer needs more frequent review.
- Ask the patient to remove shoes and socks at each visit.
- Look between the toes and at pressure points for callus, fissures and colour change.
- Test sensation with a 10 g monofilament and check pedal pulses.
- Ask about footwear, including barefoot walking and open sandals.
- Refer promptly for any break in skin in a patient with neuropathy.
Why it matters
Most diabetic foot ulcers start unnoticed in a foot that cannot feel pain.
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