Diabetic foot

Question 1

How do you begin the examination?

Answer 1

Wash/introduce/identify/explain/consent/questions
Any pain in their ankles or feet?
Expose the legs from knee to feet

Question 2

What are you looking for on inspection?

Answer 2

Gait
Shoes – signs of uneven wear, presence of foreign objects etc
Feet – deformity, intrinsic muscle wasting, pes planus (flat foot), pes cavus (high arch)
Skin –
Trophic changes – hairlessness, pallor, dry cracked skin, decreased sweating
Temperature at pressure points
Ulceration
Diabetic dermopathy – brown macules over shins
Infection – cellulitis (eryhtema + swelling), gangrene
Webspaces (spread them)– cracked, infected, ulcers etc
Toe nails – in-growing, dystrophic, paronychia, onychomycosis

Question 3

What are you looking for on palpation?

Answer 3

Palpate the bones and joints of the ankle and foot for swelling and tenderness – watching the patients face throughout and ask them to say if they feel any discomfort

Question 4

What do you look for on a vascular examination of the foot?

Answer 4

Temperature (dorsum of hand), comparing temp to shin temp bilaterally
Pulses – dorsalis pedis, posterior tibial, popliteal (if foot absent), femoral
Capillary refill

Question 5

What do you do on a neurological examination of the foot?

Answer 5

Ankle jerk reflex
Sensation – light touch, pressure – 10g monofilament (having tested centrally first) applied to the hallux and 1st, 3rd and 5th metatarsal heads; proprioception (isolate hallux distal phalanx and manipulate); vibration – at MTP joint, if absent move proximally; pinprick and temperature