• American Podiatric Medical Association (APMA), American College of Foot and Ankle Surgeons, American College of Foot and Ankle Orthopedics and Medicine, Centers for Medicare and Medicaid Services. Diabetic foot and ankle care physician performance measurement set. Bethesda (MD): American Podiatric Medical Association, Inc.; 2007 Aug. 11 p.

Does not apply to this measure

This measure is used to assess the percentage of patients aged 18 years and older with a diagnosis of diabetes mellitus who were evaluated for proper footwear and sizing during one or more office visits within 12 months.

Foot ulceration is the most common single precursor to lower extremity amputations among persons with diabetes. Shoe trauma, in concert with loss of protective sensation and concomitant foot deformity, is the leading event precipitating foot ulceration in persons with diabetes. Treatment of infected foot wounds accounts for up to one-quarter of all inpatient hospital admissions for people with diabetes in the United States. Peripheral sensory neuropathy in the absence of perceived trauma is the primary factor leading to diabetic foot ulcerations. Approximately 45-60% of all diabetic ulcerations are purely neuropathic. In people with diabetes, 22.8% have foot problems -- such as amputations and numbness -- compared with 10% of nondiabetics. Over the age of 40 years old, 30% of people with diabetes have loss of sensation in their feet.

CLINCAL RECOMMENDATION STATEMENTS:

The multifactorial etiology of diabetic foot ulcers is evidenced by the numerous pathophysiologic pathways that can potentially lead to this disorder. Among these are two common mechanisms by which foot deformity and neuropathy may induce skin breakdown in persons with diabetes. The first mechanism of injury refers to prolonged low pressure over a bony prominence (i.e., bunion or hammertoe deformity). This generally causes wounds over the medial, lateral, and dorsal aspects of the forefoot and is associated with tight or ill-fitting shoes. The other common mechanism of ulceration involves prolonged repetitive moderate stress. This normally occurs on the sole of the foot and is related to prominent metatarsal heads, atrophied or anteriorly displaced fat pads, structural deformity of the lower extremity, and prolonged walking. (American College of Foot and Ankle Surgeons/American College of Foot and Ankle Orthopedics and Medicine [ACFAS/ACFAOM] Clinical Practice Guidelines)

Diabetes mellitus; foot ulceration prevention; evaluation of proper footwear

All patients aged 18 years and older with a diagnosis of diabetes mellitus (see the related "Denominator Inclusions/Exclusions" field in the Complete Summary)

Patients who were evaluated for proper footwear and sizing at least once within 12 months (see the related "Numerator Inclusions/Exclusions" field in the Complete Summary)

Administrative data
Medical record

Measure #POD 3: diabetic foot & ankle care, ulcer prevention - evaluation of footwear.

American Podiatric Medical Association

American Podiatric Medical Association

Clinical Practice Advisory Committee of American Podiatric Medical Association (APMA) in conjunction with the American College of Foot and Ankle Surgeons (ACFAS) and the American College of Foot and Ankle Orthopedics and Medicine (ACFAOM) representing podiatric physicians from researchers, to teachers to practicing podiatrists

There were no potential conflicts of interest to report in the development of these measures.

National Quality Forum

Ambulatory Care Quality Alliance
Physician Quality Reporting Initiative

Measure was not adapted from another source.

2007 Aug

This is the current release of the measure.

• American Podiatric Medical Association (APMA), American College of Foot and Ankle Surgeons, American College of Foot and Ankle Orthopedics and Medicine, Centers for Medicare and Medicaid Services. Diabetic foot and ankle care physician performance measurement set. Bethesda (MD): American Podiatric Medical Association, Inc.; 2007 Aug. 11 p.

This NQMC summary was completed by ECRI Institute on October 3, 2008. The information was verified by the measure developer on November 12, 2008.

No copyright restrictions apply.