Diabetic Foot

Question 1

What is involved in your inspection?

Answer 1

Shoes - stitching, foreign bodies and the tread - comparing both sides!

Lower legs and feet - skin integrity (ulcers), bony abnormalities (bunions, over-riding of toes and charcots joint)

Callus and ulcer on plantar aspect of foot

Between toes for cuts and fungal infections

Look at calf and heel

ASK IF THEY HAVE HAD PREVIOUS ULCERATION

Question 2

What is after inspection?

Answer 2

Assessment of circulatory function

Question 3

How do you assess circulatory function?

Answer 3

Temperature - above knees to tip of toes

Capillary refill (compress toe nail for 5 seconds)

Pulses

Question 4

How do you assess neurological function?

Answer 4

Vibration sense

• Lateral part of big toe, midfoot, both malleoli and then knee

Soft touch on big toe

Sharp touch on big toe

Question 5

What comes after neurological screening test?

Answer 5

Monofilament screening test

• Clean monofilament before use
• Reassure that it is not sharp
  
  • 5 areas tested on each foot - random fashion

Question 6

At what point can diabetic neuropathy be diagnosed?

Answer 6

When patient feels 8/10 or less

Question 7

What comes after monofilament?

Answer 7

Muscolskeletal function

Question 8

How to assess musculoskeletal function?

Answer 8

Plantarflexion and dorsiflexion at the ankle joint

Inversion and eversion at mid-tarsal and sub-talar joints

Plantarflexion and dorsiflexion at the toes

Gait

Ask for pain and restriction of movement

Inspect for bony abnormalities/charcot’s joint, joint subluxation, high or flat arches or exostosis

Question 9

How do you close the examination?

Answer 9

Thank them

Re-dress

Further investigations such as ankle brachial pressure index

Assess self-care

Provide patient with risk specific education on foot care

Consider need for specialist referral - podiatry or vascular surgery

Question 10

What should you consider asking when assessing self-care?