In this topic you will learn how to complete a simple foot screen for people already identified as at risk of having a foot wound.
By asking questions and carrying out some simple tests, you can identify if their risk is low, moderate or high.
You will also learn what actions to take based on the risk level.
It will be helpful if you have a copy of the TAP Mobility assistive products screening form and the TAP Mobility assistive products foot screen guide with you as you work through this topic.
The foot screen will help identify:
- Risk signs – things that increase the risk of having a foot wound
- High risk signs – things that significantly increase the risk of having a foot wound.
The number of ‘risk signs’ and ‘high risk signs’ indicate a person’s overall foot wound risk.
Activity
Look at Section 3 of the TAP Mobility screen form. Note on the right hand side there are six check boxes. One check box is labeled ‘High risk sign’ and five are labeled ‘Risk sign’
Which of the following are ‘high risk signs’?
If you checked all you are correct. They are all high risk signs.
Which of the following are ‘risk signs’?
If you checked all, you are correct. They are all risk signs.
Now lets work through the foot screen process.
Note: Always wash your hands with soap and dry them before and after carrying out a foot screen.Use gloves if the person has an open wound, or if you think they may have a skin condition or infection.
Look at the person’s feet
Ask the person to take off their shoes and socks. Explain that you would like to look closely at their feet.
Make sure that you look at the top and bottom of each foot, and between each toe.
Current and previous wounds or amputation increase the chance of developing another wound. They are high risk signs.
Check the boxes on the screening form if a person has had a foot wound before, or has a toe, foot or leg amputation.
Does the person have (now) any: toe, foot or leg wounds or injuries?
Is either foot red, hot to touch or swollen?
Redness, heat and swelling are all signs of a possible infection and/or other serious conditions. These are all high risk signs.
Can you see any skin / nail problems, or unusual shape of foot / toes?
Skin or nail problems can increase the risk of a foot wound development.
Some common examples of skin or nail problems are thick, cracked or calloused skin, blisters, long or unusual shaped nails.
These are all risk signs.
This activity will help you to practice looking for risk signs associated with skin or nail problems.
Activity
Which of the feet pictured below do you think may have ‘skin or nail problems’?
This foot is healthy.
This foot has a skin problem. The area of thickened skin is called a callus. This is a risk sign for a foot wound.
These feet have a skin problem. The area of cracked skin on the heels could break down. This is a risk sign for a foot wound.
Changes in foot shape can result in areas of increased pressure on the foot. This increases the chance of a foot wound development.
Some common examples of problems people have with their feet that change their shape are bunions (bony bump at the base of the big toe) and claw or hammer toes.
Changes in foot shape can be a risk sign.
This activity will help you to practice looking for risk signs associated with changes in foot shape.
Activity
Which of the feet pictured below look healthy, and which ones have problems such as clawed toes or other unusual shape of foot and/or toes?
This foot has a bunion (bony bump at the base of the big toe). The big toe has also moved inward towards the other toes. This makes the foot wider and increases the chance of rubbing against a shoe. This can lead to a foot wound.
This foot has more than one problem. The problems are:
- Claw toes
- Bunion
- Nail problems.
Claw toes cause increased pressure on the ends of the toes. It is also harder to find a shoe that fits comfortably.
On this photograph you can see the skin on the top of the little toe is red due to shoe rubbing.
The bunion may cause the big toe joint to rub against the shoe.
The nail problems may increase pressure on the toes.
These are all risk signs for a foot wound.
These feet are healthy.
Check blood flow
A person with reduced blood flow is at a higher risk of developing a foot wound. It is also more likely that the foot wound will take longer to heal.
The foot screen provides four ways to check foot blood flow:
- Look for physical signs
- Ask if the person has pain at the back of their legs
- Carry out a pulse test
- Carry out a refill test.
Look at the person’s feet:
Can you see signs of reduced blood flow:
- Ankle or foot swelling,
- No hair on feet or toes,
- Cold or pale foot.
These are all signs of reduced blood flow and are a risk sign.
Ask the person:
Do you feel pain in the back of your legs:
- At night and/or
- While walking less than 200m
Some people may feel pain, or cramping in the back of their legs, which can be a sign of poor blood flow.
This is likely to be worse at night, and/or when a person is walking short (less than 200m) distances.
Carry out a pulse test
Good blood flow to the feet can be felt as a ‘pulse’, in the same way that a pulse can be found on your wrist or neck.
Activity
See if you can find your pulse, or the pulse of a friend of colleague.
With two fingers (do not use your thumb), find the:
Pulse test:
Can you feel both pulses on each foot?
Two main pulses in the foot are:
- On the top of the foot
- On the inside of the foot, behind the ankle bone.
To confirm that a person has good blood flow, you need to be able to easily find both of these pulses on each foot.
When testing for pulses, always use your second and middle finger, not your thumb.
No pulse is a risk sign.
Question
Why should you check for pulses with your second and middle finger, and not your thumb?
Do not use your thumb to feel for a pulse, because your thumb has its own pulse.
Watch this video to see how to carry out a pulse test.
Activity
Practice finding the two main foot pulses.
Start by trying on yourself, and then test at least 2 other people.
You may need to move your fingers around a little to find the pulse.
Carry out a refill test
Another sign of poor blood flow is when it takes more than 3 seconds for a person’s skin to regain its natural colour after it is pressed.
Refill test:
- Push the end of each big toe firmly.
- Count seconds for toe to return (refill) to normal colour.
- Note whether the refill takes less or more than three seconds.
Activity
Press firmly with your finger on your hand and then let go. Notice that your skin briefly changes colour (gets paler), and then the colour returns.
This colour change is due to a temporary block of the blood flow where you have pressed.
When there is good blood flow, as soon as the pressure is released, the skin ‘refills’ with blood within 3 seconds. The skin colour then returns to normal.
To test how quickly a person’s foot ‘refills’ (returns to usual skin colour) push firmly on their big toe.
Then let go, and count how many seconds it takes for the toe to return to normal colour.
If it takes more than three seconds for either toe, this is a risk sign.
Watch this video to see how to carry out a refill test.
Activity
Practice the refill test.
Start by trying on yourself, and then test at least 2 other people.
Check feeling (sensation)
The foot screen provides two ways to check a persons feeling in their feet:
- Ask what they feel in their feet
- Test the feeling in their feet.
Remember: A person with problems with feeling is at a risk of developing a foot wound.
Ask the person:
Do you feel any unusual feelings or pain in your feet or toes?
People may experience different unusual feelings in their feet including:
- Tingling (pins and needles feelings)
- Numbness (no feeling)
- Stabbing or sharp pain
- Burning feeling (sensation).
When asking the person if they have unusual feelings, give these examples so that they understand what ‘unusual feelings’ may be.
Carry out a sensation test
Sensation test:
With person’s eyes closed – touch the tip of toes 1, 3 and 5 on each foot with your finger or a monofilament. Alternate between each foot in the order shown in the video.
- Tick (✓) toes that feel
- Cross (x) toes that don’t feel.
Activity
Look at the screening form. Note that the pictures of the right and left foot have the toes numbered.
This shows the toes, and in which order, you will carry out the sensation test.
Practice on yourself, touching toes 1,3,5 on each foot in the order shown on the form.
To carry out a sensation test, follow these steps:
- Ask the person to close their eyes.
- Explain that you will touch their toes. They should let you know when they feel your touch.
- 3. Touch the tip of the toes toes 1, 3 and 5 on each foot with your second finger. You can also use a monofilament if you have these available.
- Touch lightly once only, for 1 second.
- Wait a few seconds between each toe to give the person time to respond.
- If the person says nothing, they have not felt the touch. Go to the next toe.
- Record on the form with a tick the toes that the person can feel and with a cross the toes they cannot feel.
If a person did not feel the touch on two or more toes, this is a risk sign.
Watch this video to see how to carry out a sensation test.
Now watch this video to see the whole foot screen carried out.
Summarize the person’s foot wound risk
Summarize the person’s foot wound risk (count the number of risk and high-risk signs ticked).
Count the number of risk signs ticked and high risk signs ticked throughout the foot screen.
Complete the table based on the number of ticks, to see if the person has a low, medium or high foot wound risk.
If a person is low risk, help them avoid a foot wound by teaching them how to care for their feet and about suitable shoes.
If a person is moderate or high risk, it is important that they are referred to a health care service or foot wound clinic for further assessment and care.
You can also:
- Teach them about how to care for their feet
- Assess to see if therapeutic footwear is suitable for them.
Activity
To complete this activity you need a copy of the mobility assistive product screening form.
Remember Jensen?
He is 60 years old and has diabetes.
You carry out a foot screen and find that:
- Jensen has had a foot wound before.
- He has thick skin on the bottom of his foot which looks like a callus.
- He says he has pain in the back of his calf at night.
- You cannot find a foot pulse on either foot.
- He could only feel three of the six toes you touched.
Fill out the foot screen section of the mobility assistive product screening form for Jensen.
Now click below to see if you completed the form correctly.
Count up the number of high risk and risk ticks to calculate Jensen’s risk level.
How high is Jensen’s risk of another foot wound?
Jensen has one high risk sign (previous foot wound) and four risk signs (a skin problem, two signs of poor blood flow and loss of feeling). He is in the high risk category.
His plan should include:
- Making sure he is seeing his health care service for diabetes management
- Teaching Jensen how to care for his feet
- Assessing Jensen for therapeutic footwear.