Foot Care Everywhere Help Documentation
Version 5.05.2007

QUICK START GUIDE
On first download, the Foot Care Everywhere application will run automatically. The user will be prompted to "Create New Database". Enter a User Name (only one allowed per database), Password, and Database Name. The database name may only contain numbers and letters - the underscore, pipe, and space characters are not permitted. The database files will be created in a directory "fce" which may reside on any drive root (including removable hard drives or flash drives). Multiple databases may exist on the same machine, but only one will be used by the application during each session. If multiple databases exist, the application will ask the user which one they would like to use on start-up.

*Note: Please write down your database password and keep it somewhere safe.

To begin entering patient data, choose "New Patient" from the "Patient" menu. This will open a calendar dialog that allows you to select the visit date (default is today). After a visit date is selected, the data entry page will open. The current visit will not appear in the "Visit Dates" section at the upper right until some data fields are saved from the form below. Enter the patient's name, provider, and referring physician (if applicable). Enter visit data into the fields in the exam sections below.

To expand a section of the exam form, click on the arrow to the left of the section title (for example: "Demographics") or double click on the name. To collapse the section, click again on the arrow to the left of the section title or expand another section. Only one section of the form may be expanded at any given time.

Patient data is saved by clicking on the "Save" button at the bottom of the data entry window. You may click the "Save" button at any time during data entry without exiting the current visit.

*Note: Visit information is not automatically saved as you work. To prevent loss of work, you may want to save portions of the exam as you complete them.

To print the data from the current visit, go to the "Report" menu and select "Print Report". A preview of the report file will appear. Click on the "print" button at the top of the preview to send the document to your printer.

For subsequent data entry/review:

New Patient:
Go to the "Patient" menu and select "New Patient". Proceed to enter patient information as described above.

Existing Patient, New Visit:
Go to the "Patient" menu and select "Find Patient". Enter search criteria in some or all of the searchable fields and click "Search". A list of patients matching the criteria will be shown at the bottom. Double click on a patient's name to open their record in the data entry window. In the "Visits" section at the top right, click the button "New Visit" to begin entering data for a new visit. The new visit will not appear in the list of visits until you have saved some data below.

Existing Patient, Review old Visit:
Go to the "Patient" menu and select "Find Patient". Enter search criteria in some or all of the searchable fields and click "Search". A list of patients matching the criteria will be shown at the bottom. Double click on a patient's name to open their record in the data entry window. All visits in the database for the current patient will be shown in the "Visits" section at the top right. To review an old visit, double click on the visit date and data from that visit will be displayed in the fields below.

After the first use, the application can be launched using the desktop icon or program menu group created during initial installation. If neither of these appears on your machine, simply return to www.footcareeverywhere.org and re-download the application.

File
Exit - Exit the Foot Care Everywhere Application. The user will always be prompted to save the current visit before exiting.

Patient Menu
New Patient - Begin entering data for a new patient who is not yet in the database.
Find Patient - Search for an existing patient in the database. Double click on the patient's name to open their file.

Report
Print Report - Generate a pdf report containing the data from the current visit. This report is intended to be shared with other medical professionals involved in the patient's care.
Export XML - Generate an xml file containing data from the current visit, all visits for the current patient, or all visits in the current database. Although these files are difficult for humans to read, they are ideal for transferring the data to another application (such as Microsoft Excel, Access, or another database) for off-line analysis.

*Note: patient data exported in pdf or xml format is no longer encrypted and may be viewed by anyone with access to the files. Please take proper precautions to protect your patient's privacy.

Help
Help - Opens this help document for viewing.
About - View the application splash screen with links to the Foot Care Everywhere and International Working Group on the Diabetic Foot web sites. To obtain the most current version, simply launch the program with an active internet connection. Foot Care Everywhere will automatically check for newer versions and download them to your machine.

1) Check boxes. This field type records the answers to yes/no questions. Left clicking on the checkbox will switch its status. By default, checked = "true" or "yes".

2) Radio buttons. This field type allows for selection between mutually exclusive answers. The circle next to the selected answer will appear filled. Clicking on the desired answer will fill-in its circle and force the circles of any alternative options to empty.

3) Drop-down boxes. This field type allows the user to select one answer from a pre-defined set of possible answers. Clicking on the arrow at the right side of the box will display all of the available answers for the data field. Click on the desired to answer to select it. The box will collapse back to it's original size and the selected answer will be displayed.

4) Multi-select boxes. This field type allows the user to select none, one, many, or all answers from a pre-defined set of possible answers. You may need to use the scroll bar at the right side of the box to see all possible answers. Press and hold the ctrl key to select multiple options (press and hold the apple key on apple machines).

5) Free text boxes. This field type allows for the unformatted entry of alphanumeric characters. Some free text boxes have limits on the number of characters they can hold.

To quickly move to the next field, press the TAB key. If the current field is a free text box, press CTRL + TAB to advance to the next field.

Context specific help may be accessed by right clicking on any field name.

Context specific help is available by right clicking on any field. Right clicking will open the help file and navigate directly to information about the current field.

DATA STORAGE
All patient data is stored in an encrypted database that resides in the root of the directory chosen during installation (default directory: C:\fce). These data files are portable and may be accessed on any computer running the Foot Care Everywhere application. When the Foot Care Everywhere application is launched, it will search for any properly formatted databases on connected root drives and provide the user with the option to use an existing database or create a new database.

Patient information is secured at the database level, meaning that each database, rather than each instance of the Foot Care Everywhere application, has an associated password. In this respect, the FCE application simply acts as a means to view and edit the database files. It also means that it is possible to copy the database files from their current location to another root drive (not within any sub folders, i.e. C:\ will work, but C:\Program Files\ will not) on the same or a different computer.

Data may be exported for import into other software in XML format using the "Report" menu or the Foot Care Everywhere application.

*Note: Removing the program files will not automatically delete the FCE database files. The database files are located in the root of the storage drive specified by the user during set-up (for example: C:\fce). Database files may be manually deleted from the system or copied to another location for storage

First Name
The patient's first name or given name.

Middle Initial
The patient's middle initial (if available).

Last Name
The patient's last name, surname, or family name.

Patient ID#
A patient identifier. This number is not used by the Foot Care Everywhere application, but rather serves as way to link the FCE database to existing patient records or other research data. This field accepts numbers, letters, or a combination of numbers and letters.

Provider
The name of the physician or person examining the patient during the current Foot Care Everywhere visit.

Referring Physician Name
The name of the physician who referred the patient (if available).

Referring Physician Contact Details
Contact details for the referring physician listed in "Referring Physician Name". This field has no format and may include any information useful for follow-up contact with the physician (for example: telephone number, address, institution).

Address
The patient's home address.

Mobile Phone Number
The patient's mobile telephone number.

Telephone Number
The patient's home telephone number.

Date of Visit
Date on which the patient was seen. If the current patient has been seen multiple times, all available visits are displayed. Data from a previous visit may be reviewed by selecting the desired visit date. To begin a new (editable) visit, click "New Visit". You may move between old and new visits during data entry by clicking on the visit date. Default format: mm/dd/yyyy.

Date of Birth
The patient's date of birth. Default format: mm/dd/yyyy.

Race
The patient's race or ethnicity. The drop-down box contains some broad classification options, but this field also accepts text entry. Options: African | Caucasian | East Asian | Oceanian | Native American

Gender
The patient's gender. Options: Male | Female.

Height
The patient's height. Units: meters

Weight
The patient's mass. Units: kg

BMI
Body Mass Index, or Quetelet Index. A measure of weight scaled by height. Normal ranges for BMI are available from wikipedia: http://en.wikipedia.org/wiki/Body_mass_index. This field is not entered, but rather automatically calculated from the patient's entered weight and height. BMI = weight/(height²). Units: kg/m².

Complaint
Reason for the patient's visit. May be a detailed description of a problem or simply "routine foot care".

History of Present Illness
Duration and course of the present complaint.

Review of Systems
A review of the current state of the patient's health. This section of the exam is intended to identify non-foot related problems that may affect foot care or require referral for additional care. The patient should be asked about the following areas:

Cerebrovascular
Ears, Eyes, Nose, Throat
Neurological
Dermatological
Cardiovascular
Muskuloskeletal
Pulmonary
Urogenital
Abdominal

Family History
A brief review of the patient's family's history of illness. This should focus on disease with high genetic risk factors such as cancer, type 2 diabetes mellitus, and cardiovascular disease.

Occupation
The patient's current occupation or "unemployed" or "retired".

Current Smoker
Does the patient currently smoke tobacco?

Smoke Quantity
Tobacco usage measured in pack-years. Pack-years are calculated by multiplying the number of packs/day by the number of smoking years. Example: The patient smoked one pack per day for 10 years, but over the past 2 years has only smoked 1/2 pack per day. Pack-years = 1*10 + 1/2*2 = 11. Units: pack-years

Current Alcohol Drinker
Does the patient currently consume alcoholic beverages?

Alcohol Quantity
Alcohol usage measured in drinks per day. One drink = 150 mL (5 oz) glass of wine, 355 mL (12 oz) of beer, or one shot (45 mL, 1.5 oz = one shot) of liquor. Units: drinks/day

DM Duration
Length of time since the patient was first diagnosed with diabetes. Units: years

DM Control
Select all methods of blood glucose control used by the patient. Multi-select Options: diet | exercise | insulin | oral medication

DM Medication
List oral medications taken by the patient for glycemic control (enter other medications only in the "Current Medications" field).

Diabetes Related PMH
Ask the patient if they have a history of the following diabetes related complications/treatments:

Claudication: Cramp-like pain in the calves caused by poor blood circulation. *If present, be sure to evaluate the ankle-brachial index.
Myocardial Infarction: Heart attack.
Stroke: Cerebrovascular Accident (CVA).
Laser Surgery: For vision correction or treatment of diabetic retinopathy.
Renal Transplant: Kidney transplant secondary to diabetic nephropathy.
Vascular Surgery: Describe any previous vascular surgery.
Lower Extremity Fracture: Describe any previous lower extremity (leg/ankle/foot/toe) fractures.
Prior Amputation: Describe any prior toe, foot, or leg amputations.
Other Foot Surgery: List any foot surgery not described above.
Prior Ulcers: List information about the patient's previous ulcers (if any). Each row in the table represents a single ulcer and includes:

Location: Foot and approximate location on the foot. Example: Dorsum of left 5th toe.
Duration: How long the patient had the ulcer.

General PMH
Description of the patient's general past medical history. Include non-foot related prior surgery, fractures, hospitalization, cancer, etc.

Current Medications
A list of all medications currently being taken by the patient and their dosages. Each row in the table represents a different medication and contains:

Name: The name of the medication.
Dosage: The patient's current dosage of this medication.

HbA1c
The patient's most recent measurement of glycosylated hemoglobin. This is a laboratory test that provides information about average glycemic control over a period of about 120 days. For more information and normal levels see: wikipedia: Glycosylated Hemoglobin. Units: %

Random Blood Glucose
The patient's most recent measurement of blood glucose (as generally measured by a finger stick test). Units: mg/dL

Vascular
Results of vascular studies (if available).

Imaging
Results from imaging studies such as X-ray, MRI, or CT (if available).

Cultures
Results of culture studies (if available).

Other
Other miscellaneous lab results.

General Appearance
Describe the general appearance of each foot.

10g Monofilament
The monofilament exam is intended to provide a semi-quantitative evaluation of loss of protective sensation in the feet. The patient should be in a sitting or reclining position with the plantar surfaces of the feet accessible to the physician. The exam should take place in a quiet relaxed setting and the patient should close his/her eyes or look away during testing so that their responses are not altered by visual feedback.

Begin by explaining the exam to the patient and touching his/her hand with the monofilament so that they know what type of sensation to expect. Proper technique is to apply the monofilament perpendicular to the skin's surface just until the filament buckles, then remove.

Vibration Sensation
Test the patient's ability to feel vibration by touching a tuning fork to the bony prominence on the patient's hallux. Options: yes | no

Reflexes
Standard clinical examination of reflexes. Options: Present | Diminished | Absent

Unsteady
Is the patient unsteady while walking? This may be a sign of motor and/or sensory neuropathy. Options: yes | no

Foot Pain Characteristics
If the subject is experiencing foot pain, read the patient the following list of pain characteristics and hold ctrl while selecting all that apply. Multi-select Options: burning | prickling | tingling | cramping | shooting pains | weakness | pain worse at night

Brachial Blood Pressure
The American Heart Association recommends that patients be seated in a chair (not reclining) for at least 5 minutes prior to brachial blood pressure measurement. The arm cuff must be appropriately sized to produce accurate measurements - most manufacturers print sizing information on the cuff itself. At least two measurements should be taken and the average of the two reported. Units: mmHg

*Note: Due to the high rate of kidney complications in diabetes, it is important to note that if the patient has an arteriovenous fistula (AV fistula) for dialysis, the brachial blood pressure should not be measured in that arm.

Ankle Blood Pressure
Ankle blood pressure should be taken with the patient reclining in a chair with the feet at approximately heart level. Cuff size is important and a larger or smaller cuff than the one used for brachial blood pressure may be required. At least two measurements should be taken and the average of the two reported. Units: mmHg

Toe Blood Pressure
The patient should be reclining with feet at approximately heart level during measurement. Special cuffs are required for the measurement of toe blood pressure. At least two measurements should be taken on each hallux and the average of the two reported. Units: mmHg

Ankle Brachial Index
The Ankle-brachial index is a measure of blood flow to the legs. Values of 0.8 or less indicate peripheral vascular disease. More information on ABIs is available from wikipedia: http://en.wikipedia.org/wiki/Ankle_Brachial_Index. This field is not entered, but rather automatically calculated from the patient's entered brachial and ankle systolic blood pressures. ABI = systolic ankle pressure / higher of the two systolic brachial pressures. Units: none

Skin Temperature
Foot temperature should be measured with the patient in a reclining position with shoes and socks removed for at least ten minutes. Units: degrees celsius

Edema
Rate any edema in each foot/ankle. Multi-select Options: 0 | +1 | +2 | +3 | +4:

0 = no edema
+1 = trace: Barely detectable. Slight pitting, no visible change in the shape of the extremity, depth of indentation <6 mm; disappears rapidly
+2 = mild: No marked change in the shape of the extremity; depth of indentation 6-12 mm; disappears in10-15 seconds
+3 = moderate: Noticeably deep pitting, swollen extremity, depth of pitting 1 -2.5 cm; duration 1-2 minutes
+4 = severe: Very swollen and distorted extremity, depth of pitting >2.5 cm; duration 2-5 minutes

Edema Comments
This field is provided to allow the user to better describe location, quality, and appearance of edema (if present).

Skin
Rate the appearance the skin on each leg using the following criteria:

Color: Select the option that best describes the patient's skin color. Options: Normal | Mottled | Cyanotic | Rubor | Pallor
Texture: Hold ctrl and select all that apply. Multi-select Options: Normal | Atrophic | Dry | Xerotic | Loss of Tone | Loss of Turgor | Loss of Elasticity
Hair Growth: Select the option that best describes the patient hair growth. Options: Normal | Diminished | Absent
Condition: Hold ctrl and select all that apply. Options: Well hydrated | Inter-digital Maceration | Dry/Peeling/Flaking

Nails
For each of the following, select all nails with the condition:

Onychomycosis: Yellow/Brown, thick, dytrophic. Multiselect Options: Left 1 | Left 2 | Left 3 | Left 4 | Left 5 | Right 1 | Right 2 | Right 3 | Right 4 | Right 5
Onychocryptosis: Ingrown. Multiselect Options: Left 1 | Left 2 | Left 3 | Left 4 | Left 5 | Right 1 | Right 2 | Right 3 | Right 4 | Right 5
Onychauxis: Nail hypertrophy . Multiselect Options: Left 1 | Left 2 | Left 3 | Left 4 | Left 5 | Right 1 | Right 2 | Right 3 | Right 4 | Right 5
Paronychia: Infection around the nail bed border. Multiselect Options: Left 1 | Left 2 | Left 3 | Left 4 | Left 5 | Right 1 | Right 2 | Right 3 | Right 4 | Right 5

Callus
Select all digits with tylommas (callus) present under the metatarsal heads (if any). Multiselect Options: 1 | 2 | 3 | 4 | 5

Hemorrhage into callus
Describe the location and appearance of any hemorrhage into callus. Hemorrhage into callus may be a precursor to ulceration and should be monitored carefully.

Heloma Durum (Corn)
Select all digits with heloma durum present (if any). Multiselect Options: 1 | 2 | 3 | 4 | 5

Warts
Describe the location and appearance of warts on the patient's feet (if present).

Scar
Describe the location and appearance of scars on the patient's feet (if present).

Foot Deformity
Select all present foot deformities. Multi-select Options: claw toes | hammer toes | prominent MTH | MTPJ limited joint mobility | Ankle limited joint mobility | HabV (bunion) | Charcot | Callus

Foot Type
Patient's foot type defined on the basis of arch height. Options: planovalgus (flat) | normal | cavus (high arch)

Current Ulcers
Detailed descriptions of the patient's current foot ulcers (if present) using the PEDIS classification system. A more detailed, printable summary of PEDIS ratings can be downloaded here.

Foot: Options: left | right
Location: Location on the foot
Long Axis: Measurement of the longest dimension of the ulcer (used for approximating ulcer area). Units: mm
Short Axis: Measurement of ulcer size perpendicular to the long axis measurement (used for approximating ulcer area). Units: mm
Depth: Ulcer depth at deepest point. Units: mm
Perfusion: Rate blood supply to the wound. Options: Grade 1 | Grade 2 | Grade 3
Grade 1 = No symptoms or signs of peripheral arterial disease in the affected foot.
Grade 2 = Symptoms or signs of peripheral arterial disease, but not of critical limb ischemia.
Grade 3 = Critical limb ischemia.
Extent/Size: The approximate ulcer size. This field is not entered, but rather automatically calculated based on the assumption of an elliptical wound with dimensions described by long axis and short axis. Units: mm²
Depth/Tissue: The depth of the ulcer as classified by levels of tissue involvement. Options: Grade 1 | Grade 2 | Grade 3
Grade 1 = Does not penetrate deeper than the dermis.
Grade 2 = Penetrating to tendons, muscle, fascia.
Grade 3 = All layers of the foot involved including bone/joint.
Infection: Rate the degree of infection. Options: Grade 1 | Grade 2 | Grade 3 | Grade 4
Grade 1 = No symptoms of signs of infection.
Grade 2 = Erythema 0.5 to 2 cm involving only the skin.
Grade 3 = Erythema > 2 cm plus involvement of structures deeper than the dermis.
Grade 4 = Signs of a systemic inflammatory response.
Sensation: Rate the degree of neuropathy. Options: Grade 1 | Grade 2
Grade 1 = No loss of protective sensation.
Grade 2 = Loss of protective sensation.
Ulcer Base: Select the option that best describes the tissue of the ulcer base. Options: Granulating | Fibrous | Necrotic
Exudate: Select all options that describe fluid exudate from the wound. Options: None | Clear | Serous | Sero-sanguinous | Purulent | Mal odor
Image: A link to a current image of the ulcer.

Plan-Impression
A description of the physician's general impression based on the foot exam. This section may also include a plan for treatment, schedule for future visits, etc.