Complications of Diabetes Assessment

Question 1

Introduction

Answer 1

WIPE QQ

Hello, I’m An a 3rd year medical student.
Can I confirm your name and DOB
I’ve been asked to examine your feet in relation to your diabetes. I’ll ask you to walk, look at, assess your sensation and reflexes

Do you have any pain in your legs?

Question 2

Gait

Answer 2

Gait
- antalgic - painful?
- broad based?
- myopathic - high steppage

Turning
-look down at feet due to impaired sensation and proprioception

Question 3

Inspection

-what are you looking for

Answer 3

Soles, sides, heels, between toes

Peripheral cyanosis, pallor - poor perfusion

Venous ulcers - gaiter, shallow, irregular
Arterial ulcers - well demarcated, deep, pressure points, hair loss
Gangrene, missing digits
Calluses - abnormal gait, poor fitting footwear

Charcot arthropathy - progressive degeneration of weight bearing joint from peripheral neuropathy
-effusion, distortion, redness, loss of joint function

Question 4

Palpation

Answer 4

Temperature - symmetrically warm
-cool, pale => poor perfusion

Pulses - femoral, popliteal, post tib, dorsalis pedis
-compare both sides

Question 5

Sensation

Answer 5

Monofilament - test on hand

• big toe
• under big toe
• under 3rd toe
• little toe
• under little toe

Vibration -dorsal columns
-test on hand => IPJ of big toe => MTP => ankle => knee

Proprioception - dorsal columns
- IPJ of big toe => MTP => ankle => knee

Ankle jerk - absent in peripheral neuropathy

Question 6

Shoe soles

Answer 6

Sole wear - asymmetrical => abnormal gait
Correct size
Materials within shoes that could cause injury

Question 7

Further investigations

Answer 7

Bedside

• Hx
• urine dip
• capillary glucose
• LL neuro exam
• fundoscopy - diabetic retinopathy
• peripheral arterial and venous exam
• foot care advise - referral to podiatry, footwear advice

Bloods

• U&E - renal function
• HbA1c, B12, folate