Diabetic Foot Exam

Inspection

General

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

Skin

• 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

• webspaces: cracked, infected, ulcers, maceration
• toe nails: dystrophic, in-grown, paronychia, Onychomycosis

Palpation

Pulses

• femoral
• popliteal
• posterior tibial
• dorsalis pedis

Temperature

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

Other

• Capillary refill

Auscultation

• Bruits: femoral, popliteal

Neurological

Sensory

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

Autonomic

• ↓ sweating
• dry cracked skin

Motor

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

Reflexes

• DTR: ↓ ankle jerk