Jump to content

Diabetic Foot Exam

From Wikiversity

Inspection

[edit | edit source]

General

[edit | edit source]
  • gait, shoes, heels,any foot ulcer or deformity.
  • 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]

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

Other OSCE modules

[edit | edit source]