Diabetic patients are at high risk for foot ulcers, infections, neuropathy, vascular disease, and amputations due to poor blood supply and nerve damage. There is loss of sensation in diabetics causing diabetic neuropathy. Earl and accurate assessment is the most important step in preventing complications.

A comprehensive Diabetic Foot Assessment identifies

• Nerve damage
• Poor blood circulation
• High-pressure points
• Foot deformities
• Deep infections
• Bone involvement
• Severity of the wound

At Happy Diabetic Foot & Podiatry Centre, we follow advanced diagnostic protocols to ensure timely treatment, faster healing, and prevention of future ulcers.

1. Neurological Assessment in Diabetic Foot

In this we detect loss of protective sensation caused by diabetic neuropathy.

We check

• Peripheral nerve function
• Sensation and reflexes
• Motor function & muscle weakness

Diabetic Neuropathy Assessment Tests done are

1. 10g Monofilament test – to assess light touch
2. Vibration test (128 Hz tuning fork) – to detect vibration sense loss
3. Pinprick sensation
4. Temperature discrimination
5. Ankle reflexes

The loss of protective sensation increases the risk of

• Painless ulcers
• Blisters
• Charcot foot
• Repeated injuries

2. Vascular Assessment for diabetic foot

It is done to evaluate blood circulation to the foot and identify PAD (Peripheral Artery Disease).

a) ABI test – Ankle Brachial Index

ABI compares blood pressure in the ankle vs. arm to indicate blockage.

Normal ABI: 0.9 – 1.3

Low ABI (<0.9): Suggests PAD

High ABI (>1.3): Calcified arteries – need Doppler evaluation

b) Doppler Ultrasound

It is done to check for

• Blood flow
• Arterial blockage
• Venous insufficiency
• Quality of circulation

If there is poor blood supply, it can lead to

• Non-healing ulcers
• Gangrene
• Risk of amputation

3. Foot Pressure Assessment

It is done to identify areas of high pressure that can cause ulcers.

Foot pressure test in diabetics measures

1. Foot pressure distribution
2. Weight-bearing abnormalities
3. Risk zones for ulcer formation
4. Effects of deformities (hammer toe, claw toe, flat foot, bunions)

The high pressure in foot can lead to

• Calluses
• Corns
• Ulcers
• Recurrent wounds

Foot or plantar press analysis guides the creation of custom diabetic footwear, insoles, and offloading devices.

4. Foot Scan & Gait Analysis

The purpose is to evaluate foot shape, arch, alignment, and walking pattern.

This test helps to assess

1. 3D foot structure
2. Arch height & pronation
3. Toe deformities
4. Joint abnormalities
5. Gait cycle (heel strike, toe-off)

5. Blood Sugar Evaluation

Tests done are

1. Fasting blood sugar
2. Post-prandial blood sugar
3. HbA1c (3-month control)
4. Random sugar during visit

Uncontrolled sugars can leads to

• Slow wound healing or foot ulcers
• High infection risk
• Neuropathy progression
• Increased chances of hospitalization

Diabetes should be under control for faster wound healing.

6. Infection Work-Up

It is essential to detect soft-tissue and deep infections.

The tests done are

1. Complete blood count (CBC)
2. ESR & CRP – inflammation markers
3. Wound swab culture & sensitivity
4. Pus culture
5. Blood culture is done if there is severe infection

It guides in

• Antibiotic selection according to pus or wound culture
• Surgical management like debridement or amputation

7. X-Ray & MRI for Bone Involvement

X-Ray detects

1. Bone erosion
2. Gas in tissues
3. Foreign bodies
4. Charcot foot changes
5. Fractures

MRI is the Gold standard for

1. Osteomyelitis (bone infection)
2. Deep abscess
3. Soft-tissue involvement
4. Early Charcot foot

8. Wound Grading Systems (Wagner Classification)

This grading system helps to decide treatment and predict healing.

Wagner Classification

Grades 0–5 based on ulcer depth & gangrene.

0 – No ulcer, high risk foot

1 – Superficial ulcer

2 – Deep ulcer, tendon/bone exposed

3 – Abscess, osteomyelitis

4 – Localized gangrene

5 – Full foot gangrene