Diabetic Foot Exam

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