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