Diabetic Foot Exam

InspectionEdit

GeneralEdit

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

SkinEdit

  • vascular insufficiency - hairlessness, pallor
  • rubor at pressure points
  • skin breakdown (portal for infections)
  • diabetic dermopathy (brown macules) over shins
  • infection: cellulitis (erythema, swelling), gangrene

OtherEdit

PalpationEdit

PulsesEdit

  • femoral
  • popliteal
  • posterior tibial
  • dorsalis pedis

TemperatureEdit

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

OtherEdit

  • Capillary refill

AuscultationEdit

  • Bruits: femoral, popliteal

NeurologicalEdit

SensoryEdit

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

AutonomicEdit

  • ↓ sweating
  • dry cracked skin

MotorEdit

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

ReflexesEdit

  • DTR: ↓ ankle jerk

Other OSCE modulesEdit