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Evaluation includes inspection and palpation to confirm bony deformities, muscle and tendon atrophy, and joint range of motion. The patient’s load balance is evaluated in the erect position, and the extent of the deformity is confirmed radiographically. Callos-ities, clavus, and evidence of worn shoe soles are important indicators of load imbalance.4-1-1-5 Skin lesionsEvidence of skin dryness, desquamation, and maceration of the interdigital spaces is associated with a high index of clinical suspicion for tinea pedis. Tinea pedis is a common skin lesion that affects approximately 40% of the adult population22） and is associated with hyperkeratosis, greater suscepti-bility to infection owing to skin dryness, aggravation of calluses, and fissuring. Lower extremity ischemia presents with reddish-purple discoloration and coldness of the skin over the ischemic areas. Alopecia and atrophy or loss of nails also indicate lower extremity ischemia. Patients who receive long-term steroid therapy show atrophic and fragile skin, and even mild irritation can cause ulcers.Nail abnormalities include ingrown and thick-ened toenails, which are usually associated with inappropriately designed footwear, an incorrect fit or manner of wearing shoes, the patient’s gait, and toe deformities such as bunions, and onychomy-cosis. Nail abnormalities affect walking balance and predispose patients to falls23）.Evaluation includes observation of skin thinning and fibrosis secondary to edema, skin atrophy secondary to chronic steroid medication, ischemic skin changes, redness secondary to deformities, evidence of calluses and clavus, and nail deformi-ties. Microscopic examination should be performed for prompt diagnosis and treatment in cases of suspected toenail onychomycosis.4-1-2 Evaluation of general condition4-1-2-1 Factors that affect skin lesionsPatients who receive chronic steroid therapy often present with atrophic fragile skin that is vulnerable to injury even with mild irritation. Generalized or localized edema leads to skin thin-ning and easy scarring, which predispose to cellu-litis. Dryness caused by diabetic neuropathy, edema, and aging is associated with itchiness, and scratching predisposes to infection secondary to impaired barrier function.4-1-2-2 Factors associated with reduced body Diseases associated with immune dysfunction, hyperglycemia, low nutrition, peripheral circula-tory disorders, and aging affect the body’s defense mechanism; even minor wounds may get severely infected, healing is delayed and the skin is predis-posed to ulcer formation and aggravation. Specifi-cally, patients with diabetes and persistent hyper-glycemia (blood glucose levels ≥250 mg/dL) show reduced ability to phagocytose neutrophils with greater susceptibility to infection.4-1-2-3 Factors associated with walking abilityPatients with cranial neuropathies, spinal disease, and osteoarthritis are susceptible to falls secondary to abnormal gait balance. Anemia and medication use (antipsychotics and anticancer drugs, among others) can also cause unsteadiness and increase the risk of falls. Patients with impaired lower extremity blood flow may develop intermittent claudication with difficulty in walking long distances. Gait imbal-ance secondary to a variety of factors may cause pain and joint deformity due to the load on the affected as well as the unaffected side.4-1-2-4 Factors that affect foot self-careDaily self-care is a fundamental principle of effective foot care; however, several factors prevent foot self-care in patients. For example, hemiplegia due to cerebral infarction, motor dysfunction due to spinal disease or limited range of motion of joints, decreased visual acuity, decreased manual dexterity, decreased cognitive ability, and decreased adher-ence are known obstacles to self-care. Additionally, housing conditions without bathrooms, financial difficulties, and lack of support affect foot self-care. Patients tend to harbor misconceptions about foot-care. For example, patients often treat calluses using scissors or clip nails sensitively, without direct visualization, which increases the risk of ulcer formation.4-1-3 Footwear evaluation Careful scrutiny of footwear is often sufficient in patients with foot lesions; shoe width, size, shape, material, sole, heel, laces, and design should be defense mechanisms217