Diabetic Foot exam

Question 1

Introduction

Answer 1

Wash hands
Introduction
Explanation
Consent
Expose lower limb

Question 2

Inspection

Answer 2

Shoes
Skin colour
Plantar aspect for ulcers, callus
Between toes for cuts, fungal infections
Lift leg to look at heel and calf
Deformities (Charcot's joint)

Question 3

Assess Circulation

Answer 3

Temp of lower limbs and toes
Capillary refill
Lower limb pulses (dorsalis pedis, posterior tibialis and popliteal)
Femoral if distal pulses non-palpable

Question 4

Assess Neurological function

Answer 4

Vibration sense (128 Hz)
Soft touch (big toe only, unless diminished)
Sharp touch (big toe only, unless diminished)
Monofilament (5 points)
Proprioception
Ankle reflexes

Question 5

Assess Musculoskeletal function

Answer 5

Plantarflexion and dorsiflexion at the ankle joint
Inversion and eversion at the midtarsal and subtalar joints
Dorsiflexion and plantarflexion at the toes
Assess gait