Monitoring
Referral to Specialist
Atypical features requiring referral to a neurologist include cases
where motor neuropathy is greater than the sensory neuropathy, the presence of
asymmetry in signs and symptoms, or rapid development and progression of
symptoms. Referral to foot care specialists is recommended in patients with moderate
to high risk of foot ulceration or amputation or patients who smoke with a
history of prior lower extremity complications, LOPS, structural abnormalities (eg
bunions, Charcot foot, hammertoes), or PAD. Immediate referral to a foot care
specialist is recommended in patients with DM with open ulceration or
unexplained swelling, erythema, or increased skin temperature.