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