Diabetic Foot Exam

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Contents 1 Inspection 1.1 General 1.2 Skin 1.3 Other 2 Palpation 2.1 Pulses 2.2 Temperature 2.3 Other 3 Ascultation 4 Neurological 4.1 Sensory 4.2 Autonomic 4.3 Motor 4.4 Reflexes 5 Other OSCE modules

[edit] Inspection

[edit] General

• gait, shoes, heels

[edit] Skin

• vascular insufficiency - hairlessness, pallor
• rubor at pressure points
• skin breakdown (portal for infections)
• diabetic dermopathy (brown macules) over shins
• infection: cellulitis (erythema, swelling), gangrene

[edit] Other

• webspaces: cracked, infected, ulcers, maceration
• toe nails: dystrophic, in-grown, paronychia, Onychomycosis

[edit] Palpation

[edit] Pulses

• femoral
• popliteal
• posterior tibial
• dorsalis pedis

[edit] Temperature

• use back of hand, compare shin to feet, bilaterally
• temperature should decrease slightly as you get toward the toes

[edit] Other

• Capillary refill

[edit] Ascultation

• Bruits: femoral, popliteal

[edit] Neurological

[edit] Sensory

• ↓ vibration (1st modality to loose, 128 Hz)
• ↓ light touch (microfilament)
• ↓ pin prick
• ↓ proprioception
• ↓ temperature
• (loss in glove and stocking distribution)

[edit] Autonomic

• ↓ sweating
• dry cracked skin

[edit] Motor

• intrinsic muscle wasting (clawed, hammer toes)
• Pes planus, Pes cavus
• Charcot joints (medial and laterial deviation at subtalar joint)

[edit] Reflexes

• DTR: ↓ ankle jerk

[edit] Other OSCE modules