Clinical Skills 2 - EXAMINATION OF THE LOWER LIMB IN A DIABETIC PATIENT Flashcards
How exposedd should the patient be in the examinatin of the lower limb in the diabetic patient?
Exposed to at least knee and remove socks
What are you looking for on inspection of the lower LIMBS?
Amputation
Swelling
Scar
Ulcers
Hair loss
Skin
Bony prominences
What do you palpate for in the examination?
Palpate for
Temperature of both- foot to knee
Pulses - dorsalis pedis and posterior tibial
In the neurological part of the examination, what do you inspect for in the lowerr limbs?
Muscle wasting
Temp and sweating
What are the two test sensations carried out in the neurological part?
What are the parts tested with these two procedures
128Hz to distal bony prominences - eg medial malleolus and 1st metatarsal
10g monofilament to 10 different spots
What are the areas in which the 10g monofilament test is carried out?
The head of the 1st, 3rd and 5th toes
And the metatarsal heads of the 1st and 3rd toe
All on each foot
What is the final thing left to inspect in the examination?
The suitability of the footwear in the patient and the wear patterns
In the diabetic patient, if they are able to feel at least one pulse and able to feel 10g monofilament with no previous deformity, what risk factor does this place them in?
Low risk
If there is
Previous ulceration or amputation
OR
absent pulses AND unable to feel
10g monofilament
What risk category?
High risk
What classifies the diabetic patient as moderate risk?
Unable to detect both pulses in a
foot
OR
Unable to feel 10g monofilament
OR
Foot deformity
OR
Unable to see or reach foot - retinopathy
If the patient is at high risk who should they be referred to?
Specialist podiatrist
If the patient is able to feel < 8/10 touches with a monofilament, then the risk of foot
ulceration is increased by what?
By 5-10 fold
