Diabetic Foot Exam

Question 1

Position of patient

Answer 1

After assessing gait:
45 degrees
Expose lower legs and feet

Question 2

Equipment required

Answer 2

monofilament
tuning fork
?tendon hammer

Question 3

Start with …

Answer 3

Gait

Question 4

Gait

Answer 4

Watch the patient walking, looking at symmetry, balance on turning if it is slow, staggered or quick, any foot drop or antalgia

Question 5

Examining footwear

Answer 5

asymmetrical wearing on soles

note any holes or material that might not be good for the patient

Question 6

Process of exam

Answer 6

Gait
Inspection
Palpation
Sensation

Question 7

Inspection

Answer 7

colour
skin
ulcers
swelling
calluses 
venous filling
deformity e.g. Charcot foot

Question 8

Dry, shiny, hair loss

Answer 8

PVD

Question 9

eczema and haemosiderin staining

Answer 9

venous disease

Question 10

On inspection ensure…

Answer 10

you look between toes and lift up leg to look at the posterior surface

Question 11

Venous ulcers

Answer 11

no/small amount of pain
larger surface area, superficial
assoc. varicose veins or venous insufficiency

Question 12

Arterial ulcers

Answer 12

very painful
deep, punched out lesion
assoc. diabetes and PVD

Question 13

Causes of swelling

Answer 13

Oedema

DVT

Question 14

Oedema due to..

Answer 14

venous insufficiency

heart failure

Question 15

Tender to palpation

Answer 15

DVT

Question 16

Calluses may indicate…

Answer 16

poorly fitting shoes

Question 17

Palpation

Answer 17

Temperature
Cap refill
Pulses

Question 18

Cold lower limb

Answer 18

PVD

Question 19

Hot lower limb

Answer 19

Cellulitis

Question 20

Absent peripheral pulses=

Answer 20

PVD

Question 21

Sensation tests

Answer 21

Monofilament

Tuning fork

Question 22

Monofilament procedure

Answer 22

Test on patients arm so they know what to expect
Patients eyes CLOSED
Press firmly so the filament bends
Ask patient to say when they feel it

Question 23

How many places do you test?

Answer 23

5
big toe, and top of 3rd toe
then 4 metatarsal heads

Question 24

If they have a scar or callus what do you do?

Answer 24

Test surrounding skin, avoid the callus or scar itself

Question 25

What tuning fork?

Answer 25

128Hz

Question 26

Sensation procedure?

Answer 26

Test on patients sternum so they know what it feels like
eyes CLOSED
place on distal phalanx of great toe
patient tells you when they can feel it, and when it stops
if can’t feel it, move proximally

Question 27

Other tests to consider

Answer 27

ankle jerk reflex

Question 28

Ankle jerk

Answer 28

dorsiflex foot
tap tendon hammer over achilles tendon
observe calf for contraction- if not present= advanced PVD

Question 29

suggestion for further tests

Answer 29

peripheral vascular exam
lower limb neuro exam
bedside blood glucose
advice on foot care