Diabetic Foot Examination

Question 1

What are you looking for around the bed?

Answer 1

Walking aid

Any special shoes

Question 2

What are you looking for on general inspection?

Answer 2

Any missing digits
Obvious swelling
Obvious Ulcers
Body habitus

Question 3

How would you begin the examination?

Answer 3

Look at the patients walk for any limp/foot drop

Look at shoes to see if they are well fitted, are they evenly worn down on the soles

Question 4

What are the different sections you are looking at on inspection of the feet and legs?

Answer 4

Skin - colour, dryness, ulcers, calluses (under the foot)
Nails - look for any fungal infections
Muscles - wasting, bony abnormalities, claw toes (charots neuropathy)

Question 5

How would you distinguish between an arterial and venous ulcer?

Answer 5

Arterial - toes and pressure points, foot cool and dry, pulse absent, pain can be severe

Venous - medial malleolus, lateral calf, foot warm, pulse present, pain is mild

Question 6

What are you looking for on palpation (vascular)?

Answer 6

Temperature of foot and legs
Capillary refill of big toes
Feel pulses

Question 7

What are you looking for on palpation (neurological)?

Answer 7

Sensation - using monofilament

Vibration - on big toes

Question 8

If you thought there was any loss of sensation what would you do?

Answer 8

Test pin prick sensation

Test reflexes

Question 9

Which reflexes do you check?

Answer 9

Ankle reflexes

Question 10

How would you complete the examination?

Answer 10

ABPI
Full lower limb neurological examination
Full peripheral vascular examination
Bedside capillary blood glucose and HBA1c