Diabetic foot exam

Question 1

What things are done at the beginning of a diabetic foot exam?

Answer 1

• Asses gait (peripheral neuropathy can cause slow, painful, unsteady gait)
• Inspect footwear (for uneven wear, anything causing injury)

Question 2

What are you looking for on inspection in a diabetic foot exam?

Answer 2

Inspect all aspects of lower limb (including between toes and behind heel)
- Colour (cyanosis/pallor/erythema): poor perfusion/infection
- Ulcers (arterial/venous)
- Scars
- Missing limbs/toes/fingers
- Hair loss/decreased sweating/dry skin: autonomic dysfunction
- Infection (gangrene/cellulitis)
- Calluses: abnormal gait, poor footwear
- Deformities: high arch/flat foot, clawed/hammer toes

Question 3

What do you need to palpate in a diabetic foot exam?

Answer 3

• Temperature
• Bones/joint tenderness
• Capillary refill
• Posterior tibial pulse
• Dorsalis pedis pulse

Question 4

What is tested for the neurological assessment in a diabetic foot exam?

Answer 4

• Sensation with a monofilament
• Vibration
• Proprioception
• Ankle reflex
  
  • test sensations in the toes, if not present move higher

Question 5

What further assessments could be done to complete a diabetic foot exam?

Answer 5

• Bedside capillary blood glucose
• HbA1C
• Lower limb neurological exam
• Peripheral vascular exam