How to assess skin and nail changes in the feet of people with diabetes

Current guidelines relating to
the diabetic foot advise that all
patients with diabetes should
receive regular assessment
of their lower limb circulation
(vascular assessment) and regular
testing for loss of sensation in the
feet (neurological assessment)
(Scottish Intercollegiate
Guidelines Network [SIGN], 2001;
National Institute for Health and
Clinical Excellence [NICE], 2004).
However, it is also important that
professionals involved in diabetes
care provide regular visual
examination of the lower limb.
Changes to the skin can give an
early indication of the patient’s
circulatory and neurological status
as well as ulceration risk.
Evidence from trials studying
the impact of podiatry in the
prevention of diabetic foot
ulceration shows that regular
care of skin and nail problems
by podiatrists results in a lower
occurrence of ulceration for
Caroline McIntosh and Veronica Newton are Senior Lecturers in Podiatry, University of Huddersfi eld, Yorkshire
Patients with diabetes mellitus are more prone to ulceration and infection than non-diabetics. Routine
skin assessment allows detection of early changes. Patients presenting with skin or nail conditions
should receive prompt referral to podiatry for skilled debridement and regular palliative care to
prevent ulceration. This article will examine the important stages of the assessment process.
diabetic patients (Ronnemaa et
al, 1997; Plank et al, 2003). The
diabetic foot should therefore
be inspected regularly for skin
abnormalities, breaks in the skin
or pressure lesions.