Diabetic Foot

Question 1

Dry/shiny/hair loss

Answer 1

PVD

Question 2

Eczema/haemosiderin staining

Answer 2

Venous disease

Question 3

Other things to look for

Answer 3

Ulcers
Gangrene
Missing limbs, toes, fingers

Question 4

Cool knee

Answer 4

PVD

Question 5

Hot knee

Answer 5

Cellulitis

Question 6

Dorsalis pedis

Answer 6

Posterior to medial malleolus

Question 7

Posterior tibial pulse

Answer 7

Lateral to extensor hallucis tendon

Question 8

Squeeze calves

Answer 8

Tenderness suggests critical ischaemia or DVT

Question 9

Sensation

Answer 9

Light touch with monofilament
Vibration sense with 128Hz
Proprioception
Ankle jerk reflex

Question 10

Reduced speed in gait

Answer 10

May be reduced in patients with advanced peripheral neuropathy

Question 11

Stance- broad based gait

Answer 11

Associated with advanced peripheral neuropathy to increase stability

Question 12

High-stepping steps

Answer 12

May indicate foot drop

Question 13

Turning

Answer 13

Patients with peripheral neuropathy may look down at their feet whilst turning due to impairment of sensation and proprioception

Question 14

Further tests

Answer 14

Lower limb PNS
Peripheral vascular exam
Bedside cap glucose
Bloods (HbA1c)