People with diabetes are at higher risk for a variety of foot health problems. A diabetic foot exam checks people with diabetes for these problems, which include infection, injury, and bone abnormalities. Nerve damage, known as neuropathy, and poor circulation (blood flow) are the most common causes of diabetic foot problems.

Neuropathy can make your feet feel numb or tingly. It can also cause a loss of feeling in your feet. So if you get a foot injury, like a callus or blister, or even a deep sore known as an ulcer, you may not even know it.

Poor circulation in the foot can make it harder for you to fight foot infections and heal from injuries. If you have diabetes and get a foot ulcer or other injury, your body may not be able to heal it fast enough. This can lead to an infection, which can quickly become serious. If a foot infection is not treated right away, it can become so dangerous that your foot may need to be amputated to save your life.

Fortunately, regular diabetic foot exams, as well as home care, can help prevent serious foot health problems.

A diabetic foot exam is used to check for foot health problems in people with diabetes. When ulcers or other foot problems are found and treated early, it can prevent serious complications.

People with diabetes should get a diabetic foot exam at least once a year. You may need an exam more often if your feet have any of the following symptoms:

• Tingling
• Numbness
• Pain
• Burning sensation
• Swelling
• Pain and difficulty when walking

You should call your health care provider right away if you have any of the following symptoms, which are signs of a serious infection:

• A blister, cut, or other foot injury that doesn't start to heal after a few days
• A foot injury that feels warm when you touch it
• Redness around a foot injury
• A callus with dried blood inside it
• An injury that is black and smelly. This is a sign of gangrene, the death of body tissue. If not treated promptly, gangrene can lead to amputation of the foot, or even death.

A diabetic foot exam may be done by your primary care provider and/or a foot doctor, known as a podiatrist. A foot doctor specializes in keeping feet healthy and treating diseases of the feet. The exam usually includes the following:

General assessment. Your provider will:

• Ask questions about your health history and any previous problems you've had with your feet.
• Check your shoes for proper fit and ask questions about your other footwear. Shoes that don't fit well or are otherwise uncomfortable can lead to blisters, calluses, and ulcers.

Dermatological assessment. Your provider will:

• Look for various skin problems, including dryness, cracking, calluses, blisters, and ulcers.
• Check the toenails for cracks or fungal infection.
• Check between the toes for signs of a fungal infection.

Neurologic assessments. These are a series of tests that include:

• Monofilament test. Your provider will brush a soft nylon fiber called a monofilament over your foot and toes to test your foot's sensitivity to touch.
• Tuning fork and visual perception tests (VPT). Your provider will place a tuning fork or other device against your foot and toes to see if you can feel the vibration it produces.
• Pinprick test. Your provider will gently poke the bottom of your foot with a small pin to see if you can feel it.
• Ankle reflexes. Your provider will check your ankle reflexes by tapping on your foot with a small mallet. This is similar to a test you may get at an annual physical, in which your provider taps just below your knee to check your reflexes.

Musculoskeletal assessment. Your provider will:

• Look for abnormalities in the shape and structure of your foot.

Vascular assessment. If you have symptoms of poor circulation, your provider may:

• Use a type of imaging technology called Doppler ultrasound to see how well blood is flowing in your foot.

You don't need any special preparations for a diabetic foot exam.

There are no known risks to having a diabetic foot exam.

If a problem is found, your foot doctor or other provider will likely recommend more frequent testing. Other treatments may include:

• Antibiotics to treat foot infections
• Surgery to help with bone deformities

There is no treatment for nerve damage to the foot, but there are treatments that can relieve pain and improve function. These include:

• Medicine
• Skin creams
• Physical therapy to help with balance and strength

If you have questions about your results, talk to your health care provider.

Foot problems are a serious risk to people with diabetes. But you can help keep your feet healthy if you:

• Take care of your diabetes Work with your health care provider to keep your blood sugar at a healthy level.
• Get regular diabetic foot exams. You should get your feet checked at least once a year, and more often if you or your provider finds a problem.
• Check your feet every day. This can help you find and address problems early before they get worse. Look for sores, ulcers, toenail cracks, and other changes in your feet.
• Wash your feet every day. Use warm water and mild soap. Dry thoroughly.
• Wear shoes and socks at all times. Make sure your shoes are comfortable and fit well.
• Trim your toenails regularly. Cut straight across the nail and gently smooth edges with a nail file.
• Protect your feet from excess heat and cold. Wear shoes on hot surfaces. Don't use heating pads or hot bottles on your feet. Before putting your feet in hot water, test the temperature with your hands. Because of reduced sensation, you can burn your feet without knowing it. To protect your feet from cold, don't go barefoot, wear socks in bed, and in the winter, wear lined, waterproof boots.
• Keep blood flowing to your feet. Put your feet up when sitting. Wiggle your toes for a few minutes two or three times a day. Stay active, but choose activities that are easy on the feet, such swimming or biking. Talk to your provider before starting an exercise program.
• Don't smoke. Smoking reduces blood flow to the feet and can make wounds heal slowly. Many diabetics who smoke need amputations.

A neurological exam is a group of questions and tests to check for disorders of your nervous system. It's sometimes called a "neuro" exam.

Your nervous system includes your:

• Brain and spinal cord, which are also called your central nervous system
• Peripheral nerves that carry signals back and forth between your central nervous system and all parts of your body, including your skin, muscles, and organs

Your nervous system plays a role in almost every part of your health and well-being. Because it controls so many body processes, a neurological exam has many different types of tests. The tests you have will depend on why you're having the exam. There are nerve tests to check for problems with your:

• Muscle movement, balance, and coordination. These activities are controlled by nerves called motor nerves.
• Breathing, heartbeat, digestion, and other processes that happen without thinking. Autonomic nerves control these activities.
• Sense of touch, smell, hearing, and vision. Sensory nerves carry this information from your senses to your brain.
• Thinking and memory. Certain parts of your brain control these and other types of complex mental activity, including your emotions.

A neurological exam may be used to:

• Check the health of your nervous system during a routine checkup.
• Help find out whether a nervous system disorder is causing certain symptoms. There are hundreds of disorders that affect the brain and nerves. Some examples include:
  • Degenerative nerve diseases, such as certain types of dementia and Parkinson's disease
  • Diabetic nerve problems
  • Epilepsy
  • Headache disorders, such as migraines and cluster headaches
  • Meningitis
  • Multiple sclerosis
• Help find out if an injury has damaged part of the nervous system and how serious the damage may be.
• Monitor a known nerve condition and/or see if treatment is helping.

You may need a neurological exam if you have symptoms that may be from a nervous system disorder. Because your nerves affect every part of your body, nervous system disorders can cause many different types of symptoms, including:

• Pain in your back, neck, head, or along a nerve, such as sciatica
• Tremors
• Weak or stiff muscles
• Problems with balance and/or coordination
• Numb or tingling skin
• Changes in any of your senses (hearing, vision, taste, smell, and touch)
• Slurred speech
• Confusion or other changes in mental ability
• Seizures

You may also need a neurological exam if you have had an injury that may have damaged your peripheral nerves, spinal cord, or caused a traumatic brain injury (TBI).

A neurological exam is often done by a neurologist. A neurologist is a doctor who specializes in diagnosing and treating disorders of the nervous system. Certain other providers may also do a neurological exam.

The exam is usually done in a provider's office. If you've had a serious injury, the exam may be done in the emergency room or in the hospital.

First, the provider will usually:

• Ask questions about any symptoms you may have
• Ask about your medical history
• Do a physical exam, including checking your heart and lungs

Next, the provider will do specific tests to check how different parts of your nervous system are working. The tests you have will depend on your symptoms. The tests may check your:

• Mental status. This includes your memory, problem-solving ability, alertness, and mood. During a mental status exam, you may answer questions about the date, time, and where you are. You may also be asked to remember a list of items, name objects, repeat words, and/or draw specific shapes.
• Cranial nerves. These 12 nerves connect your brain with your eyes, ears, nose, face, tongue, throat, shoulders, and certain organs. The provider will test the nerves that may be involved with your symptoms. For example, to test your sense of smell, you may be asked to sniff certain smells and identify what they are. If you're having speech problems, you may be asked to try to talk while you stick out your tongue.
• Coordination, balance, and walking. These tests check how well your nervous system controls your muscle movements. You may be asked to walk in a straight line, placing one foot directly in front of the other. Other tests include checking your handwriting and having you touch your finger to your nose with your eyes closed.
• Reflexes. A reflex is your body's automatic movement in response to certain triggers. For example, if your knee is tapped with a rubber hammer, your lower leg will jerk on its own. There are many types of reflexes that are tested in different ways. Reflex tests show how well nerves between your spinal cord and muscles are working.
• Sensory nerves. The provider may test how well you can feel touch, hot and cold temperatures, vibrations, and pain. These tests involve gently touching part of your skin with different objects, such as a dull needle or a cotton swab. You will be asked to describe what you can feel.
• Autonomic nervous system. A neurological exam tests the part of your nervous system that controls your breathing, heart rate, digestion, and other processes that happen without thinking. Examples of these tests include checking your blood pressure and heartbeat. Another test checks how your eyes respond to light.

You don't need any special preparations for a neurological exam.

There is no risk to having a neurological exam.

If the results of any part of your neurological exam are not normal, your provider will probably order more tests to help make a diagnosis. The tests will depend on what type of condition your provider thinks you could have. They may include:

• Blood and/or urine tests
• Imaging tests, such as an MRI
• Cerebrospinal fluid (CSF) testing, also called a lumbar puncture
• Biopsy
• Electroencephalography (EEG) or electromyography (EMG), which use small electric sensors to measure brain activity and nerve function

If you have questions about your results, talk with your neurologist or other provider.

Nervous system disorders and mental health problems can have similar symptoms. For example, problems paying attention could be a symptom of either type of disorder. So in certain cases, your provider may do a mental health screening before or after a neurological exam.