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DEMO Evidence Based Diabetic Foot Risk Screening Tool -- Level 1 Summary. HNHB LHIN Wide Foot Care Working Group. Presented in Partnership. Presented by Feet First Steps To Health Diabetic Foot Care Program. Connie Comtois-Spitman- Presenter

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demo evidence based diabetic foot risk screening tool level 1 summary

DEMO Evidence Based Diabetic Foot Risk Screening Tool -- Level 1 Summary

HNHB LHIN Wide Foot Care Working Group

presented by feet first steps to health diabetic foot care program
Presented byFeet First Steps To Health Diabetic Foot Care Program
  • Connie Comtois-Spitman- Presenter
  • LHIN Wide Foot Care Best Practices Working Group/ Provider Team - Producer
  • Lori Makarchuk-OTN / Operations
diabetes action group report 2008 recommendations
Diabetes Action Group Report 2008 Recommendations
  • All individuals diagnosed with diabetes in the HNHB LHIN receive an annual foot exam by a regulated health care professional
  • Health care providers within the LHIN provide evidence based foot care that is appropriate to the provider/ seek appropriate referral
  • No cost Diabetic foot care service be made available to those found to be at high risk

Develop LHIN wide, Multidisciplinary

community initiative for the evidence based

assessment , education and treatment of basic

foot care issues related to diabetes.

diabetic foot screening tool users
Diabetic Foot Screening Tool Users
  • Level 1 Point of contact// Multidisciplinary Diabetes Health Care team.
  • MD, NP, BSN, RN,RD, Pharm,( may be RPN, homecare under medical directive), Diabetic Educators CDE
  • Level 2 Specialized foot care Chiropodist/ Podiatrist/ Physician
  • ( in addition, BSN, RN, ENT with advanced training)
  • Level 3 Specialized High Risk Referral, Neurologist, Vascular Surgeon, Orthopod, Infectious Disease, Plastics, Derm etc
summary 60 sec diabetic foot screening tool
Summary60 sec Diabetic Foot Screening Tool
  • Vascular assessment ( Pulse, Cap refill, appearance)
  • Neurological assessment ( monofilament/ vibration on-off method, pain report)
  • Skin/ Nails ( condition/ self care/ deformity)
  • Footwear/ hosiery assessment ( condition/fit/ appropriateness)

Vascular assessment REVIEW

Capillary refill time

( 3 sec or less)

Presence of Pedal Pulses

( Dorsalis Pedis)

Skin Temperature

( Hot/ Cold)

Dependant Rubor/ Erythema/ Odema

( red, irritated, swolen )


Neurological Assessment for Sensory Loss Includes

Monofilament testing score 10 sites ( x/10 )

*using Semmes Weinstein 10g monofilament

Vibration test

*using on/ off method 128 MHz tuning fork to

dorsal aspect great toe proximal to nail.

skin assessment review
Skin Assessment REVIEW
  • Identification of lesions toes, dorsum, plantar, heel, toes, between toes
  • Presence of corns, callus, blisters
  • Open areas eg
  • Fissures/ Ulceration
  • ( duration/ appearance should be documented)
nail assessment review
Nail Assessment REVIEW
  • Thickness ( normal, crumbled, broken)
  • Discolored ( black, brown, yellow, reddish)
  • Bruised, loose or missing
  • Condition/ Self care manageable?
footwear hosiery assessment
Footwear/ Hosiery Assessment
  • Look for signs of wear, including integrity of materials inside and on the sole
  • Fit and distortion of shoe shape
  • Fit of stockings indicated by indentation on legs/ toes
  • Appropriateness ie thermal in winter, or walking shoes for daily activity etc
  • Can they retain the foot?
resource flow chart
Resource Flow Chart

Self Management

Goal Setting / Problem Solving

High Risk Intervention

Vascular, Ortho

Nero, Endo

Wound Care

(Level 3)



Refer to Foot Care Program


Chiropodist / Podiatrist (Level 2 )

Level 1 Foot Screen

evidence based vascular assessment
Evidence Based Vascular Assessment
  • Capillary Refill time (1)protocol
  • Dorsalis Pedis Pulse (2)location and assessment


2 A. Mowlavi et al, Postgrad Med J, 2002. 78:746-747

evidence based neurological assessment
Evidence Based Neurological Assessment
  • Validity of the Semmes Weinstein 10g monofilament examination Level 1/ Class A Evidence
  • Assessment using Superficial pain sensation and vibration by on-off method are both well established with Level 1/ Class A Evidence
  • Recommendation of minimum of Annual Screening for the patient with the Diabetic Foot, although more frequent screens may be indicated based of level of risk

Feng Y. , Schlosser FJ, Sumpio BE, J Vasc Surg 2009 Sep 50(3) 675-82:

Kamel N et al J Diabetes Complications 2005 Jan-Feb 19(1)47-53

OlaleyeD., Perkins BA.,Bril V Diabetes Res Clin Pract. 2001 Nov.54(2)115-28:

diabetes guidelines reviewed
Diabetes Guidelines Reviewed

Canadian Diabetes Association-Clinical Practice Guidelines or the Prevention and Management of Diabetes in Canada 2008

Registered Nurse’ Association of Ontario-Reducing Foot Complications for People with Diabetes ( Nursing Best Practice Guideline) 2007

Best Practice Recommendations for the Prevention, Diagnosis and Treatment of Diabetic Foot Ulcers: Update 2010 Canadian Association Wound Care

Diabetes Care Program Nova Scotia( Best Practice Clinical Guideline Diabetic foot care

LEAP ( Lower Extremity Amputation Prevention)

lhin wide foot care best practices working group provider team
LHIN Wide Foot Care Best Practices Working Group/ Provider Team
  • Connie Comtois-Spitman-(Chair) NHCHC Feet First Steps to Health ( Chiropodist)
  • Dr. Vance Pegado- DRCC (Physician Lead )
  • Bo Fusek- DRCC ( CDE)
  • Crystal Poyton- Quest CHC ( PHCNP)
  • Michelle Overholt- Grandriver CHC (PHCNP CDE)
  • Cathy Jager- Joseph Brant CHC ( CDE)
  • Elenore Wormald-Medical Group Niagara FHT( CDE)
  • North Hamilton Community Health Centre
  • Feet First Steps to Health Diabetic Foot Care Program Hamilton/ Niagara
  • Quest Community Health Centre
  • Diabetes Regional Coordination Centre
  • Ontario Telehealth Network
  • References are available upon request