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Screening Tool www.cawc

60-second diabetic Foot ScreenScreening Toolinlow Name: Clinician Signature:ID number: Date:Look 20 secondsScoreCare RecommendationsLeft FootRight Foot1. Skin0 = intact and healthy1 = dry with fungus or light callus2 = heavy callus build up3 = open ulceration or history of previous ulcer2. Nails0 = well-kept1 = unkempt and ragged2 = thick, damaged, or infected3. Deformity0 = no deformity2 = mild deformity4 = major deformity4. Footwear0 = appropriate1 = inappropriate2 = causing traumaTouch 10 secondsLeft FootRight FootCare Recommendations5. Temperature Cold0 = foot warm 1 = foot is cold6. Temperature Hot0 = foot is warm1 = foot is hot7. Range of Motion0 = full range to hallux1 = hallux limitus2 = hallux rigidus 3 = hallux amputationAssess 30 secondsLeft FootRight FootCare Recommendations8.

60-second Diabetic Foot Screen Screening Tool inlow’S www.cawc.net Patient Name: Clinician Signature: ID number: Date: Look – 20 seconds Score

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  Screening, Tool, Screening tools, Diabetic

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