Diabetic Foot Exam

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Inspection[edit]

General[edit]

  • gait, shoes, heels,any foot ulcer or deformity.

Skin[edit]

  • 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]

Palpation[edit]

Pulses[edit]

  • femoral
  • popliteal
  • posterior tibial
  • dorsalis pedis

Temperature[edit]

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

Other[edit]

  • Capillary refill

Auscultation[edit]

  • Bruits: femoral, popliteal

Neurological[edit]

Sensory[edit]

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

Autonomic[edit]

  • ↓ sweating
  • dry cracked skin

Motor[edit]

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

Reflexes[edit]

  • DTR: ↓ ankle jerk

Other OSCE modules[edit]