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214vascular system. Qualifications that provide a wide range of knowledge regarding overall footcare include footcare instructors certified by the Japa-nese Society of Footcare and Podiatry and certifica-tion provided by the same society. Each of these qualifications trains professionals in a specific area of expertise; therefore, footcare nurses acquire multiple qualifications to provide comprehensive footcare and to compensate for the lack of knowl-edge and skills.Qualified footcare nurses are engaged in foot care outpatient clinics at medical centers, dialysis clinics, and nursing homes7, 8）. However, not all qualified footcare nurses are engaged in footcare; there is a shortage of trained footcare nurses and medical centers and care facilities that provide foot care in Japan9）.3. Role of footcare nursesFootcare nurses provide the following services: (1) professional footcare, (2) management of the footcare team and, (3) patient education to improve awareness regarding the importance of footcare.Implementation of footcare based on technical expertise and skills is important and includes not only direct patient care but also self-care and reha-bilitation guidance and adjustment of the treatment environment.In the absence of specialized podiatry services in Japan, a multidisciplinary team-based approach that includes a footcare team is necessary for management of foot disorders. Compared with other professionals, footcare nurses have more direct patient interaction and can better under-stand patients’ backgrounds and possible difficul-ties associated with treatment. Therefore, the foot-care nurse is best suited for coordination with the multidisciplinary team to facilitate patient referrals for specialized treatment10）.Despite the increasing need for footcare, medical, nursing, and welfare personnel in Japan are not particularly familiar with footcare services. Educa-tion of personnel involved in footcare is essential to provide appropriate footcare to patients with foot disorders. Moreover, the expression “footcare” is not widely recognized in Japanese society, and indi-viduals with foot lesions tend to neglect these issues. Footcare nurses play a key role in education of medical, nursing, and welfare professionals regarding the importance of timely attention to foot lesions to maintain walking ability and for improvement of overall social awareness.4. Evaluation and implementationof foot careIn this section, we will discuss evaluation neces-sary for the implementation of footcare and the contents of a footcare program.4-1 Evaluation4-1-1 Foot EvaluationIn foot care, proper evaluation of the foot is very important. This chapter describes each item of foot evaluation.4-1-1-1 Lower extremity blood flow disordersPatients with lifestyle-related diseases such as diabetes mellitus, dyslipidemia, hypertension, hyper-uricemia, chronic kidney disease, obesity, and smoking should be considered high-risk patients for arteriosclerosis obliterans11）. During the early stages of lower extremity blood flow disorders, patients may experience only a sense of coldness; however, disease progression invariably manifests as intermittent claudication, and many patients seek medical attention for evaluation of this symptom. However, intermittent claudication also occurs in patients with lumbar spinal canal stenosis. There-fore, it is important to remember that patients with blood flow disorders may visit an orthopedic surgeon, and accurate diagnosis may be delayed. Patients with impaired blood flow through the lower extrem-ities are susceptible to ulceration secondary to skin erosion and often develop intractable ulcers even after minor skin injuries. Additionally, severe lower extremity edema can lead to gangrene.Physical examination should include measure-ment of skin temperature and color tone, palpation of the popliteal, posterior tibial, and dorsalis pedis, evaluation of hair loss, subjective symptoms, and the presence and extent of erosions and ulcers. Notably, friction may result in interdigital ulcers; therefore, careful foot inspection is necessary to ensure that no area is overlooked. Such evaluation can be performed merely through observation and palpation and does not require sophisticated equip-ment; such examinations can be performed by home healthcare and nursing home personnel. Measurement of blood flow using the ankle-bra-