Diabetic Foot Exam
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Inspection[edit | edit source]
General[edit | edit source]
- gait, shoes, heels,any foot ulcer or deformity.
Skin[edit | edit source]
- vascular insufficiency - hairlessness, pallor
- rubor at pressure points
- skin breakdown (portal for infections)
- diabetic dermopathy (brown macules) over shins
- infection: cellulitis (erythema, swelling), gangrene
Other[edit | edit source]
- webspaces: cracked, infected, ulcers, maceration
- toe nails: dystrophic, in-grown, paronychia, Onychomycosis
Palpation[edit | edit source]
Pulses[edit | edit source]
- femoral
- popliteal
- posterior tibial
- dorsalis pedis
Temperature[edit | edit source]
- use back of hand, compare shin to feet, bilaterally
- temperature should decrease slightly as you get toward the toes
Other[edit | edit source]
- Capillary refill
Auscultation[edit | edit source]
- Bruits: femoral, popliteal
Neurological[edit | edit source]
Sensory[edit | edit source]
- ↓ vibration (1st modality to lose, 128 Hz)
- ↓ light touch (microfilament)
- ↓ pin prick
- ↓ proprioception
- ↓ temperature
- (loss in glove and stocking distribution)
Autonomic[edit | edit source]
- ↓ sweating
- dry cracked skin
Motor[edit | edit source]
- intrinsic muscle wasting (clawed, hammer toes)
- Pes planus, Pes cavus
- Charcot joints (medial and laterial deviation at subtalar joint)
Reflexes[edit | edit source]
- DTR: ↓ ankle jerk