Diabetic Foot Exam

Question 1

What to ask

Answer 1

Does the pt have a hx of:

• previous leg/foot ulcer or lower limb amputation/surgery
• prior angioplasty, stent, or leg bypass surgery
• foot wound requiring more than 3 weeks to heal
• do they smoke or use other sources of nicotine
• do their feet or legs burn, tingle
• have they noticed any changes in skin color or skin lesions
• do they see a podiatrist on a regular basis

Question 2

dermatologic exam

Answer 2

• the skin is …. (dry flaky etc)
• absence of hair on … (toes feet lower legs)
• ingrown toenail present on. .
• toenails (thickened, ingrown, mycotic, hypertrophic)
• skin b/w toes (macerated, nl, erythematous)
• signs of fungal infection
• any open wounds or fissures

Question 3

foot exam

Answer 3

• document presence of existing ulcers: (location, size)
• presence of toe deformities (partial or complete amputation, hammer toes, clawed toes)
• abnl shape of foot (partial or complete amputation, bunions, rocker-bottom)
• presence of callus (state location, size, focal and/or heavy) or corn (location)

Question 4

vascular exam

Answer 4

• dorsalis pedis (present, absent) posterior tibial pulse (present, absent)
• ask about ABI
• presence of swelling (venous stasis, infection)
• temp (warm to touch, cool to touch, location)
• is there a temp difference b/w the calves and the feet, or b/w the left and right foot?

Question 5

neuropathy screening

Answer 5

• monofilament exam: loss of sensation (right and left)

- abnl perception of vibration w/ tuning fort (right and left)

Question 6

biomechanical foot assessment

Answer 6

• plantar flexion/ dorsiflexion of ankles and great toes diminished in (left or right foot)
• do they have full ROM of the joints?
• foot deformities present? if yes, how long?
• is midfoot hot, red, inflamed?