Diabetic Foot Evaluation Flashcards
Equipment for evaluation
monofilament, tuning fork, thermometer, pedigraph
Bony prominences
Abnormal weight bearing forces bottom of feet secondary to bony prominences with lack of sensation in the feet or diabetic ulcerations
Missing digits
60% of all LE amputations
Even a small cut or injury can lead to ulceration to amputation.
Morton’s toe
Shortened first metatarsal in relation to second metatarsal.
Causes callusing and discomfort on 2nd metatarsal.
Charcot foot
Weakening of the bones of the foot which can lead to severe deformity, disability, even amputation.
Occurs in people with nerve damage.
Skin Integrity
Color, calluses, corns, edema, fungus, temperature, vascularity, toenails, gangrene.
Red/hot skin = sign of infection
redness alone = sign of rubbing/skin breakdown
Gangrene - urgent attentions
Fungus - athlete’s foot, infection of skin/nails or in between toes.
Monofilament
5.07 monofilament test is used to assess protective sensation.
Monofilament is pressed in 7 locations across the plantar surface and one on the dorsum of the foot.
Tuning Fork
Used to assess protective sensation.
Peripheral neuropathy can be measured by Vibration Perception Threshold (VPT) using a 128 Hz tuning fork.
Placed on medial malleolus
Counted seconds from when the patient can’t feel vibration to when the clinician can’t feel vibration.
Positive test = <8 seconds
Test is repeated on medial aspect of first metatarsal
Vascular Status
Delayed capillary refill time (CFT) suggest small artery disease.
Normal CFT = <3 seconds
Delayed CFT = >3 seconds (suggests peripheral artery disease)
Check pulses on dorsalis pedis & anterior tibial artery
Hair Growth
Absence of normal hair growth = sign of poor circulation
Biomechanics
Pedograph of foot to reveal problematic areas during gait.
