Why People with Diabetes Need Annual Foot Exams – What We Check For

Why People with Diabetes Need Annual Foot Exams – What We Check For

If you have diabetes, your feet deserve special attention. An annual comprehensive foot exam is one of the most important preventive care measures you can take. At Central Florida Foot & Ankle Institute, Dr. Carli Hoover emphasizes that a single annual exam—combined with daily self-care—can prevent serious complications that might otherwise lead to hospitalization or amputation.

Why Annual Exams Are Essential for Diabetes

Diabetes affects your feet in multiple ways:

• Neuropathy: Nerve damage means you might not feel pain from injuries
• Impaired circulation: High blood sugar damages blood vessels, slowing healing
• Weakened immunity: Diabetes reduces your body's ability to fight foot infections
• Skin changes: Diabetes causes dryness, cracks, and reduced elasticity

These changes happen silently. Many people with diabetes don't realize they have foot problems until they're serious. A comprehensive annual exam detects early warning signs before they become emergencies.

Studies show that annual foot exams combined with patient education and proper footwear reduce the risk of foot complications by up to 50%. That's a powerful reason to schedule your exam. The APMA diabetes and your feet page says regular checkups by a podiatrist—at least once a year—are the best way to keep your feet healthy if you have diabetes.

What Happens During Your Annual Diabetic Foot Exam

The Detailed History

Dr. Carli Hoover begins by asking detailed questions:

• Your diabetes history: How long you've had diabetes, how well controlled it is, complications you've experienced
• Foot symptoms: Any pain, numbness, burning, tingling, or changes in sensation
• Previous foot problems: Ulcers, infections, wounds that didn't heal well
• Medications: Including those for blood sugar, blood pressure, and circulation
• Current foot care routine: Daily inspection habits, nail care, moisturizing
• Footwear: Types of shoes you wear, how well they fit
• Activities: Exercise, standing at work, travel that might stress your feet
• Smoking: Critical because smoking severely impairs circulation
• Kidney disease: Affects healing capacity

This conversation provides context for what we find during the physical exam.

The Comprehensive Physical Examination

We examine both feet systematically, comparing side to side.

Visual Inspection:

• Skin color and texture: Redness, pallor, or unusual discoloration suggests circulation problems
• Swelling: One foot swollen more than the other indicates inflammation or infection
• Calluses and corns: These indicate pressure points where ulcers often develop
• Cracks and fissures: Especially around the heels, these invite infection
• Skin temperature: We feel both feet and compare—warmth suggests inflammation
• Fungal infections: Discolored, thickened toenails or between-toe maceration
• Foot deformity: Bunions, hammertoes, flat feet, high arches—all affect weight distribution and ulcer risk
• Hair loss: Absence of leg and foot hair suggests poor circulation
• Prominent veins or lack of veins: Indicates vascular status

Nail Assessment:

• Thickness and texture (diabetes causes nails to become brittle)
• Color changes (dark discoloration suggests fungal infection or melanoma)
• Ingrown nails (risk for infection)
• Fungal infection signs
• Proper length and shape

Your podiatrist may clean under nails to examine for infection or melanoma.

Assessment of Circulation

Good circulation is essential for healing. We evaluate blood flow using:

• Manual palpation: Feeling for pulses in your feet and legs
• Dorsalis pedis pulse (top of foot)
• Posterior tibial pulse (inside ankle)
• Palpation reveals whether pulses are strong, weak, or absent

• Capillary refill test: Pressing on toenails and watching how quickly color returns (normally 2-3 seconds)
• Delayed return suggests poor circulation

• Doppler ultrasound (if pulses are weak or absent): Assesses blood flow velocity in your legs
• Determines if arteries are narrowed
• Guides decisions about vascular referral

• Ankle-brachial index (ABI): Comparing blood pressure in your arms vs. ankles
• ABI less than 0.9 indicates peripheral arterial disease (PAD)
• Significantly impacts healing capacity
• May require vascular intervention

People with diabetes have high rates of peripheral arterial disease, which dramatically impairs wound healing. Identifying PAD early allows vascular specialists to intervene before serious complications develop.

Neuropathy Screening: Testing for Nerve Damage

Since nerve damage is the biggest risk factor for diabetic foot complications, thorough neuropathy testing is essential.

Monofilament Testing (the most important test):

• We use a thin 10-gram nylon filament
• We touch specific points on your foot (top, bottom, sides, between toes)
• You close your eyes and tell us when you feel the touch
• If you can't feel the filament on certain areas, you've lost protective sensation
• Loss of protective sensation is a major warning sign for ulcer risk

Vibration Testing:

• Using a vibrating tuning fork
• We apply it to bony areas (ankle bone, top of foot)
• You tell us when you stop feeling vibration
• Inability to sense vibration indicates significant neuropathy

Temperature Sensation:

• We apply warm and cold objects to your feet
• You should be able to distinguish temperature differences
• Inability to do so indicates sensory neuropathy

Reflex Testing:

• We test your Achilles and patellar (knee) reflexes
• Absent reflexes indicate neuropathy
• Reflexes correlate with nerve function

Proprioception (Position Sense):

• We move your toes passively
• With eyes closed, you tell us whether they move up or down
• Inability to sense position indicates proprioceptive loss

These tests determine your level of neuropathy and guide our recommendations for footwear, activity, and follow-up frequency.

Structural Assessment

Foot Structure and Alignment:

• Arch height (flat feet, high arches, or normal)
• Foot shape (wide, narrow, deformed)
• Toe alignment (hammertoes, overlapping toes)
• Ankle stability
• Gait assessment (how you walk)

Structural issues affect where pressure concentrates on your feet. Pressure points are common sites for ulcer development.

Bone and Joint Evaluation:

• Checking for signs of Charcot foot (bone destruction from neuropathy)
• Assessing mobility and stability
• Palpating bones and joints for deformity
• Identifying joint fusion that might indicate Charcot foot

Skin and Wound Assessment

If you have any existing skin changes, wounds, or areas of concern:

• Detailed documentation of location, size, depth
• Culture if infection is suspected
• Photography for comparison at future visits
• Wound measurements to track healing

What About X-Rays or Advanced Imaging?

While not needed for every annual exam, X-rays are taken if:

• You have foot deformity suggesting Charcot foot
• Previous ulcers are healing
• There's suspicion of bone involvement in infection
• New symptoms develop

The Footwear Consultation

One of the most valuable parts of your annual exam is the footwear discussion:

Proper shoe fit is critical for preventing ulcers. We assess:

• Whether your current shoes fit properly
• If special diabetic shoes are needed
• Appropriate cushioning for your foot type
• Whether custom insoles or orthotics would help
• Proper shoe depth for neuropathy or deformity

Ill-fitting shoes are a major cause of diabetic ulcers. We can prescribe custom diabetic shoes (often covered by insurance) that provide superior protection.

Your Blood Sugar Control Discussion

Dr. Carli Hoover reviews:

• Your most recent HbA1c (average blood sugar over 3 months)
• Your target HbA1c with your primary care doctor
• Whether your current management is achieving goals
• Recommendations for better control (in consultation with your doctor)

Blood sugar control directly impacts:

• Healing capacity
• Infection risk
• Neuropathy progression
• Circulation

Improving blood sugar control has the single biggest impact on preventing foot complications.

The Neuropathy and Circulation Conversation

We discuss your results:

• Whether you have neuropathy and how severe it is
• Your circulation status (good vs. concerning)
• What these findings mean for your foot health
• Whether vascular referral is needed
• How these findings impact your activity recommendations

Creating Your Personalized Foot Care Plan

Based on everything we've found, we create a customized plan including:

• Follow-up frequency: Most diabetic patients need annual exams, but those with complications may need more frequent visits
• Footwear recommendations: Including whether custom diabetic shoes are needed
• Daily care instructions: Proper foot hygiene, inspection routine, moisturizing
• Activity recommendations: Safe exercise considering your neuropathy and circulation
• Referrals: To vascular surgery, endocrinology, or other specialists if needed
• Prevention strategies: Specific to your risk factors

Special Considerations During Your Exam

If you smoke, we discuss smoking cessation. Smoking dramatically worsens circulation and impairs healing. This is the most important lifestyle change you can make.

If you have kidney disease, we note this affects healing. May require more intensive foot care.

If you've had previous ulcers, you're at very high risk of recurrence. We're especially vigilant and may recommend more frequent visits or more aggressive preventive measures.

If you have poor circulation (confirmed by Doppler or ABI), we may refer you to a vascular surgeon for evaluation of arterial disease.

Documentation and Records

We maintain detailed records of:

• All examination findings
• Foot measurements and photographs
• Neuropathy and circulation test results
• Any wounds or skin changes
• Recommendations and patient education provided
• Your foot care plan

These records track changes over time, helping us spot developing problems early.

After Your Exam: What Happens Next?

If everything is normal:

• Schedule your next annual exam
• Follow your personalized foot care plan
• Continue daily self-exams
• Call if any problems develop between visits

If problems are found:

• We discuss treatment options
• May need more frequent follow-up
• May need referrals to other specialists
• May need custom shoes or orthotics
• Your plan adapts based on findings

Why You Shouldn't Wait Until Something Hurts

Without neuropathy, you'd feel pain when problems develop. But diabetic neuropathy means you might not feel anything until significant damage has occurred. This is why waiting for pain to develop is dangerous.

Annual exams catch:

• Circulation problems before they cause serious complications
• Neuropathy before preventive measures can no longer help
• Early skin changes before they become ulcers
• Fungal infections before they spread
• Structural problems before they cause deformity

Make Your Annual Exam a Priority

Your feet carry you through life. With diabetes, they deserve expert attention at least annually. Dr. Carli Hoover and our team at Central Florida Foot & Ankle Institute make annual diabetic foot exams thorough, compassionate, and focused on preventing complications.

We're available at our Lake Mary and Downtown Orlando clinics: Lake Mary (Waymont and MedPlex) and Downtown Orlando / SODO. People also drive in from Sanford, Altamonte, and Longwood — we do not have offices in those towns. Call (407) 307-0006 or book at https://floridafai.intakeq.com/booking to schedule your comprehensive annual foot exam today. Your feet will thank you.

Related reading

• Diabetic Foot Care in Downtown Orlando, FL – Wound Prevention & Screening
• Diabetic Foot Care in Lake Mary, FL – Specialized Podiatry Screening