Healthy Feet (Continued)
Diabetic Foot Risk Classification System: Where Do You Stand?
To keep the legs you stand on, it might help for you to better understand your "risk" for having a foot ulcer or worse, an amputation. 85% of all lower extremity amputations start with a foot ulcer. So preventing the ulcer almost guarantees keeping your foot and leg. When you look at this classification system, think about yourself and where you fit. Then, read the recommendations for "ongoing care." If you follow those recommendations, you can reduce your risk. These guidelines were developed by The International Working Group on the Diabetic Foot (IWGDF) and are accepted worldwide.
To understand your risk for developing a foot ulcer, you must first have a foot exam to determine whether or not you have protective sensation for pain with your feet. This is normally done with a monofilament-testing device. If you do not feel the monofilament-testing device you have what is called LOPS. The number listed next to the Risk Category represents your "odds" of developing a foot ulcer, which, as you will learn, can be a "trigger" towards developing a foot ulcer and ultimately needing an amputation.
Risk Category 0
Foot Ulcer Risk Odds= 0/1
This is the lowest-risk for a person with diabetes. You are in this category if you CAN feel the monofilament-testing device and have what is called "protective sensation for pain." You have no history of a foot ulcer and no foot deformity.
You should be educated about diabetes, practice preventive foot care behaviors, keep your blood sugars under control and see a foot care specialist once a year for reevaluation. If you DO NOT have the ability to sense pain in your foot, you have what is called LOPS or "loss of protective sensation for pain." That places you in one of the three following catego¬ries. A foot health history by a foot care specialist and foot examination will help define your specific foot problems of the bones, soft tissues, and nails and place you in the correct category.
Risk Category 1
Foot Ulcer Risk Odds= 1.7/1
You are in this category if you have lost protective sensation for pain, but have no foot deformities or history of ulcers to your feet.
You should be educated about diabetes, practice preventive foot care behaviors, control your blood sugars, and see a foot care specialist once a year for reevaluation. You will be encouraged NOT to walk barefooted, and may be advised to wear a preventive, cushioned insole for shock absorption and protection from shearing forces against the foot.
Risk Category 3
Amputation Risk Odds=12.1/1
You are in this category if you have lost protective sensation for pain and have a foot deformity of the bones, soft tissues, or nails.
You should be educated about diabetes, practice preventive foot behaviors, control your blood sugars, and see a foot care specialist several times a year. You may benefit from insoles or custom made biomechanical orthotics and/or special diabetic shoes to relieve pressure or to accommodate a deformed foot. For your callus, corn, and nail trimming you should use the services of a foot care specialist, especially if you also have poor vision or hand-eye coordination.
Risk Category 4
Foot Ulcer Risk Odds= 36.4/1
If you are in this category, you are at the highest risk for foot ulcers, infections and amputation. You have lost protective sensation for pain and you may have a history of a previous foot ulcer, bone infection, amputation, Charcot Foot, circulation problems, gangrene, or a diagnosis of kidney disease.
You should be seen by a foot care specialist at least every two months, depending on your needs. You will be evaluated for insoles, shoes, braces, or the appropriate treatment for your foot health needs and ongoing foot care.
On www.dr-mark.net, you can find The Comprehensive Diabetic Foot Health Survey. It will help you to identify your risk factors for foot ulcers infections and amputations and provide recommendations for prevention and educational information to help you maintain good foot health.
Many people say that depression is a side effect or complication of diabetes. Without discounting the association of the psychological condition with the physical one, I'm not convinced that our high and/or unstable glucose levels are directly responsible for that change in our mental state. My belief is that the unrelenting need for self-care, for following the sort of care schedules that can drive licensed, professional caregivers crazy, is what overwhelms us...