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