Diabetic Foot Exam

Inspection

  • General: gait, shoes, heels
  • Skin
    • Vascular insufficiency (hairlessness, pallor)
    • Rubor at pressure points
    • Skin breakdown(portal for infections)
  • Shin: diabetic dermopathy (brown macules)
  • Infection: cellulitis (erythema, swelling), gangrene
  • Webspaces: cracked, infected, ulcers
  • 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
Capillary refill



 

Auscultation

Bruits: femoral, popliteal

Neurological

Sensory

  • ↓ vibration (1st modality to loose, 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)

DTR: 

  • ↓ ankle jerk

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