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Click ‘Get Form’ to open the foot assessment form in the editor.
Begin by entering your name and date of birth in the designated fields. Ensure accuracy for proper identification.
Indicate your Medicare number and answer the diabetic status question by checking 'Yes' or 'No'.
Proceed to the 'EXAM FINDINGS' section. Here, select options that best describe your skin condition, nails, structure, anatomy, sensation, and vascular health by checking the appropriate boxes.
In the 'FOOT CARE' and 'FOOTWEAR' sections, assess your current practices and mark any areas needing improvement or education.
Complete the risk assessment by assigning a score based on your findings. This will help determine necessary actions.
Finally, ensure you sign and date the form at the bottom before saving or sharing it directly from our platform.
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Your provider will check: The skin of your feet to look for dryness, cracking, calluses, blisters, ulcers, and other damage or abnormal areas. Your toenails for cracks and fungal infection. The temperature of your feet to see if they are the same.
What is included in a foot assessment?
Comprehensive Foot Evaluation This includes assessing circulation, sensation, skin and nail condition, as well as any structural or biomechanical issues that may be present.
How to document a monofilament foot exam?
1. Record the number of sites felt out of the total number of sites tested as per above. 2. If the monofilament was not felt in a particular site on the foot, this loss of protective sensation finding is to documented and communicated to the clients care team.
What is the assessment of foot care?
Foot assessment provides an opportunity for early identification of issues and can help prevent long-term impact on physical function and quality of life. Access to quality foot care is associated with preventing complications (such as major lower extremity amputation), increasing quality of life, and decreasing pain.
What is a physical assessment of the foot?
Physical Examination of the Foot The patient is observed from behind while standing on toes; contraction of the gastrocnemius, the degree of heel inversion, the height of the foot arch, and the degree of lateral symmetry are assessed.
The assessment should include: The persons medical history including history of foot problems An examination of the feet A check of foot pulses and reflexes A footwear assessment An assessment of the persons understanding of foot health An assessment of the persons self‑care capacity.
What is included in a podiatry assessment?
A review of your medical status and a footwear evaluation will take place along with a few simple and painless tests. These tests are to check the circulation in your feet and to discover if you have normal sensation in your feet.
What are the 5 principles of foot care?
Basic care for healthy feet Wash your feet every day and dry them completely. Clip your toenails short and keep them clean. Change your socks at least once a day. Check your feet regularly for cuts, sores, swelling, dryness, and infected toenails and apply treatment as needed.
pdf foot assessment form
Patient Update Form
Foot Assessment Form. Part I Patient Information (to be filled in by the patient). Name: Home Phone Number: Address: Work Phone Number: Date of Birth: Shoe
Protective sensation. (Can feel 10 gm filament or better at all test sites). Loss of protective sensation. (Does NOT feel 10 gm filament and NO HD deformity).
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