assessment tips

As a provider, your job is to help your patient feel comfortable and help them take care of their foot health. One way to help your patient with their foot issues is to get a proper diagnosis and get them in suitable footwear.

Before measuring the patient for their diabetic shoes, it’s essential to assess their feet.

According to Medicare DMEPOS, when fitting for therapeutic shoes and inserts, an assessment is conducted for the following six reasons:

  1. To assess the patient's overall need for the shoes. This includes a comprehensive history, pertinent medical information, and allergies to skin condition diagnosis which is on the patient's prescription and previous use of shoes.
  2. To help determine the most appropriate shoes and inserts based on the patient's need to ensure optimum therapeutic benefits, and proper function as required.
  3. To formulate a treatment plan consistent with the prescribing physician's order, and consult that physician when necessary.
  4. To perform a diagnosis-specific clinical examination as related to the patient's need for the footwear.
  5. To establish goals and expected outcomes of the patient's use of the shoes. Examples of the expected results would include reducing pain, increasing comfort, enhancing dependence, or preventing deformities, or promote healing.
  6. To disclose any potential risks, benefits, and precautions to the physician and the patient.

Keep in mind; the primary goal is to assess the patient's need for the footwear as it relates to the prescription and provide him or her with the most appropriate shoes and inserts. As you do a foot assessment, follow a few of these helpful tips.

Privacy

The foot assessment should be conducted in a private room. Something where the door can close, or a partition, so you’re away from the other employees or patients of the facility.

Wear Gloves

Your patient may have an open wound or fungus on his or her foot. Wearing gloves will not only protect you but also protect your patient from infection.

Perform on Both Feet

The assessment should also be conducted on both feet because not all feet are the same. So, assess both feet to make sure you recommend the correct shoes or inserts.

Start the Assessment

Have the patient remove his or her shoes and socks, and then have him or her roll up their pants, so you have a complete view of the foot and ankle. Look at the shoes worn into the appointment to notice gait wear patterns. You can also remove the insert or orthotic to understand the different wear patterns as well as the length and size.

Biomechanical Side Assessment

Ask the patient to flex their foot. Have the patient put all their weight down on their foot and then lift the foot up. You’re looking for a decreased range of motion. If there’s range of motion difficulties, that would increase plantar or potentially increase plantar pressure. So, if you notice any range of motion limitations, indicate that on the patient's chart or in the foot assessment notes.

Plantarflexion and Dorsiflexion Assessment

Here you’ll look at the great toe, also known as the big toe. Have the patient flex and point the toe to notice the range of motion. Jot down any if the patient has any struggles with the range of motion.

Ankle Adduction and Abduction Assessment

To conduct this assessment, grab the patient's heel and the forefoot across the metatarsal heads. Abduction is away from the midline; adduction is towards the midline. So, look for any limited range motion.

Inversion and Eversion Assessment

In this assessment, you’re looking for that range of motion with inversion (toes move inward) and eversion (toes move outward). Again, you’re looking for the range of motion. Write down if you notice any range of motion limitations.

Dermatological Assessment

In this assessment, look around the foot and in between the toes for any wounds, ulcers, lesions, corns or abnormalities in the patient's foot because it could lead to some infection. You’ll want to note what you notice on the assessment form. You should also check the patient’s toenails to see if they are properly cut. Toenails should be trimmed straight across, rather than curved. If they are curved, your patient can be at risk for ingrown toenails.

Again, you’re not trying to diagnose anything, just assess the patient's overall needs.

Vascular Assessment

There are a few parts to this assessment.  First, you’ll want to get the temperature of the patient’s foot. You can use a non-contact digital thermometer. It's basic to use, and you don’t even have to touch the patient's skin. It's a matter of just touching it, pulling the trigger, and you’ve assessed the plantar surface temperature. Write that number on the chart. Do this on both feet to make sure have quantitative results.

If you don’t have a non-contact digital thermometer assessment tool, warm to the touch or cool to the touch would be sufficient as well. Wear gloves when you perform this test.

The next vascular study is to notice if there’s any digital hair growth. If your patient has digital hair growth that could indicate good circulation. Loss of digital hair growth could mean a loss of circulation or lack of flow within the foot.

Then, look for overall color. Pay attention to see if the foot color matches the patient’s leg. Indicate the skin color and if you notice any blues or purples or anything out of the ordinary.

Capillary Assessment

The capillary refill test is relatively simple. With your finger, apply 2 to 3 seconds of pressure on the patient’s toe, and let go for 2 to 3 seconds. Within that timeframe, the color should refill back into the patient's toe. On the form, jot down the length of time it took to refill those capillaries.

Texture Assessment

Look at the patient’s foot for how the overall texture is. Notice it’s fragile, thin, or shiny—or if there’s severe edema or other issues.

Pulse Assessment

Finally, you’ll want to do a pulse assessment. There are two pulses that you can check on a patient's foot. One is called the posterior tibial pulse, which is behind the ankle bone called the medial malleolus. And, the other is between the ankle bone and the Achilles tendon. For this assessment, you don’t need to get the beats per minute. Instead, you’re checking for the presence or absence.

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The contents of this blog were independently prepared, and are for informational purposes only. The opinions expressed herein are those of the author and are not necessarily indicative of the views of any other party. Individual results may vary depending on a variety of patient-specific attributes and related factors.