Diabetic Foot Exam

Question 1

How would you start the examination?

Answer 1

1. Wash hands
2. Introduce self
3. Identify patient
4. Gain consent and ask if any pain in ankles or feet
5. Expose both legs from knees to feet

Question 2

What would you do on inspection?

Answer 2

General inspection
Assess gait
Inspect shoes - uneven wear or orthotics/insoles
Inspect patient’s feet - under heel, soles and between toes and on top of feet too

Question 3

What are you inspecting the feet for?

Answer 3

hairlessness, pallor, dry cracked skin, rubor, ulcers, dermopathy over shins, cellulitis, gangrene, cracked webspaces, dystrophic toe nails, paronychia, onychomycosis, muscle wasting (clawed toes), calluses, pes planus, pes cavus

Question 4

What do you do on palpation?

Answer 4

Palpate the bones and joints of the feet for swelling and tenderness
Watch patient’s face and ask them to tell you if in pain

Question 5

What do you do for the vascular aspect of examination?

Answer 5

1. Assess temperature (shins to feet bilaterally)
2. Pulses (dorsalis pedis and posterior tibial) - say femoral or popliteal would be done if foot pulses absent
3. Capillary refill

Question 6

What are the key aspects of neurological examination for the foot?

Answer 6

1. Reflexes - ankle
2. Sensation - light touch, pressure, proprioception, vibration
3. Say you would do pin-prick and temperature sensation to complete

Question 7

How would you assess light touch sensation?

Answer 7

Not sure - but use cotton wool and assess tips of toes first then work proximally
If time, test dermatomes too.
Work from left to right feet rather than doing one foot at a time

Question 8

How do you assess pressure sensation?

Answer 8

10g monofilament - on sternum first to check sensation

Then close eyes and apply perpendicularly until it buckles on 1st, 3rd and 5th metatarsal heads (2 seconds each)

Question 9

How would you assess vibration?

Answer 9

(often 1st modality to lose)
128Hz tuning fork - sternum then 1st MTPJ
Ask to close eyes and say if they feel it vibrate and when it stops
If not present at 1st MTPJ, move proximally by joints

Question 10

How would you finish the exam?

Answer 10

Thank the patient
Ask them to redress
Wash hands

Question 11

What would you say to complete the examination?

Answer 11

Femoral and popliteal pulses if foot pulses absent
Pin-prick and temperature sensation
Full neurovascular assessment of lower limb