Diabetic Foot Exam Flashcards
Position of patient
After assessing gait:
45 degrees
Expose lower legs and feet
Equipment required
monofilament
tuning fork
?tendon hammer
Start with …
Gait
Gait
Watch the patient walking, looking at symmetry, balance on turning if it is slow, staggered or quick, any foot drop or antalgia
Examining footwear
asymmetrical wearing on soles
note any holes or material that might not be good for the patient
Process of exam
Gait
Inspection
Palpation
Sensation
Inspection
colour skin ulcers swelling calluses venous filling deformity e.g. Charcot foot
Dry, shiny, hair loss
PVD
eczema and haemosiderin staining
venous disease
On inspection ensure…
you look between toes and lift up leg to look at the posterior surface
Venous ulcers
no/small amount of pain
larger surface area, superficial
assoc. varicose veins or venous insufficiency
Arterial ulcers
very painful
deep, punched out lesion
assoc. diabetes and PVD
Causes of swelling
Oedema
DVT
Oedema due to..
venous insufficiency
heart failure
Tender to palpation
DVT
Calluses may indicate…
poorly fitting shoes
Palpation
Temperature
Cap refill
Pulses
Cold lower limb
PVD
Hot lower limb
Cellulitis
Absent peripheral pulses=
PVD
Sensation tests
Monofilament
Tuning fork
Monofilament procedure
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
How many places do you test?
5
big toe, and top of 3rd toe
then 4 metatarsal heads
If they have a scar or callus what do you do?
Test surrounding skin, avoid the callus or scar itself
What tuning fork?
128Hz
Sensation procedure?
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
Other tests to consider
ankle jerk reflex
Ankle jerk
dorsiflex foot
tap tendon hammer over achilles tendon
observe calf for contraction- if not present= advanced PVD
suggestion for further tests
peripheral vascular exam
lower limb neuro exam
bedside blood glucose
advice on foot care
