Presentation And Diagnosis

Stage 1 is the normal foot. By definition, it does not have the risk factors for ulceration, namely neuropathy, ischaemia, deformity, callus and swelling. The diagnosis of stage 1 is made by excluding these factors.

A full foot assessment consisting of history, examination and simple investigations is described in the introduction.

Ideally this should be carried out on the first presentation of a patient. The assessment will need to be adapted when it is used for a screening examination as part of the annual review.

Foot screening may be carried out by any suitably trained health-care professional.

The screening assessment consists of four parts:

• Enquiry for past or present ulceration

• Testing for neuropathy with 10-g monofilament

• Palpation of foot pulses to detect ischaemia

• Inspection of the foot to look for the following abnormalities:

Deformity

Callus

Swelling

Ulceration

Signs of infection

Necrosis.

Patients with none of these problems are classified as stage 1. However, the screening of stage 1 patients should be repeated at yearly intervals to ensure that patients who develop risk factors are restaged and offered treatment as appropriate.

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