Diabetes lower limb examination

Question 1

look

Answer 1

Examine legs and all surfaces of both feet, including heels, plantar surfaces, between toes, bony prominences, and toe nails.
Look for amputations, ulcers (venous and arterial), scarring, pallor, erythema, haemosiderin deposition, hair loss (and distribution), swelling, callous formation, muscle wasting, and bony deformities (such as Charcot rocker- bottom foot).

Question 2

Palpate

Answer 2

Temperature (cold if ischaemic).
Sweating (autonomic).
Pulses – posterior tibial and dorsalis pedis. Peripheral oedema.
Capillary refill time.

Question 3

sensation

Answer 3

Use a 10g monofilament to check sensation at five points on each foot, avoiding callouses and ulcers.
Apex of first and third toes.
First, third, and fifth metatarsal heads.

Question 4

footwear

Answer 4

Check suitability of shoes.
Look for unusual/asymmetrical wear patterns.