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. 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 in