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Phase 2b Medicine > Diabetic Foot Examination > Flashcards

Diabetic Foot Examination Flashcards

1
Q

What should be done in the introduction of a diabetic foot exam?

A
  • Wash hands
  • Introduction, identification and consent
  • Ask if any pain in feet or ankles
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2
Q

What should be noted on inspection on diabetic foot?

A
  • Gait
  • Shoes
  • Skin
  • Feet specifically
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3
Q

What are the four things to note when assessing the gait of a diabetic foot patient?

A
  • Speed
  • Stance
  • Steps
  • Turning
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4
Q

In what condition is gait speed reduced in a diabetic foot exam?

A

Advanced peripheral neuropathy

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5
Q

Which type of stance may indicate an advanced peripheral neuropathy and why?

A
  • A broad-based gait

- Done to increase stability

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6
Q

What kind of steps indicates the presence of foot drop?

A

High-stepping

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7
Q

What may present with turning in patients with peripheral neuropathy and why?

A
  • May find it difficult
  • May look down at their feet while turning
  • This is due to impairment of sensation and proprioception
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8
Q

What are the three things to note about footwear in a diabetic foot exam?

A
  • Pattern of wear of the soles
  • Check the shoes are the correct size
  • Ensure no materials in the shoe which may cause injury
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9
Q

What may asymmetrical wear of the shoes mean in a diabetic foot patient?

A

An abnormal gait

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10
Q

What changes to the skin should be noted in a diabetic foot patient?

A
  • Trophic changes
  • Pallor/cyanosis
  • Rubor at pressure points
  • Ulceration
  • Dermopathy
  • Infection
  • Changes to toenails
  • Missing digits/limbs
  • Scars
  • Calluses
  • Venous guttering
  • Charcot arthropathy
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11
Q

What are trophic changes of the foot?

A
  • Pallor
  • Decreased sweating (autonomic dysfunction)
  • Dry cracked skin
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12
Q

What does hair loss of the feet/legs indicate in a diabetic patient?

A

Chronic impairment of tissue perfusion in PVD

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13
Q

What is peripheral pallor?

A

A pale colour of the skin that can indicate poor perfusion

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14
Q

What is peripheral cyanosis?

A

Bluish discolouration of the skin associated with low SpO2 in the affected tissues

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15
Q

What can occur at the pressure points in a diabetic foot patient?

A

Rubor

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16
Q

What are the two types of ulceration which can occur in a diabetic foot patient?

A

Venous & arterial

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17
Q

How do venous ulcers present?

A
  • Large and shallow
  • Irregular borders
  • Mildly painful
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18
Q

Where do venous ulcers usually present?

A

The medial aspect of the ankle

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19
Q

How do arterial ulcers present?

A
  • Small and deep
  • Well defined border
  • Very painful
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20
Q

Where do arterial ulcers usually present?

A

The most peripheral regions of a limb

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21
Q

Where does diabetic dermopathy usually present and what is it?

A

Brown macule - over the shin

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22
Q

What are the two types of infection which can present with diabetic foot?

A

Cellulitis & gangrene

23
Q

How does cellulitis present?

A

Erythema & swelling

24
Q

What is the brief pathophysiology of gangrene?

A

Tissue necrosis secondary to inadequate perfusion

25
Q

What is the typical appearance of gangrene?

A

Change in skin colour and breakdown of associated tissue

26
Q

What may occur between the fingers/toes in a diabetic foot exam?

A
  • Cracks
  • Infections
  • Ulcers
  • Maceration
27
Q

What are the 4 things which would occur on the toenails in a diabetic foot exam?

A
  • Dystrophy
  • Ingrowing toe nails
  • Paronychia (infection of the nails)
  • Onychomycosis (fungal infection of the nail)
28
Q

What may missing fingers/limbs/toes mean on a diabetic foot exam?

A

Amputation secondary to critical ischaemia

29
Q

What may scars indicate on a diabetic foot exam?

A

Previous surgical procedures e.g. bypass surgery or healed ulcers

30
Q

What may foot calluses indicate on a diabetic foot exam?

A

An abnormal gait and/or poorly fitting footwear

31
Q

What is venous guttering and when is it present?

A
  • When veins have a small blood supply, due to poor supply, so gives a ‘guttered appearance’
  • May be present with diabetic foot
32
Q

What is Charcot arthropathy?

A

The progressive degeneration of a weight-bearing joint due to peripheral neuropathy

33
Q

What are the 4 typical features of a Charcot’s joint?

A
  • Effusion
  • Distortion
  • Overlying erythema
  • Loss of joint function
34
Q

What 3 deformities would you inspect for in diabetic foot?

A
  • Intrinsic muscle wasting
  • Per planus
  • Pes cavus
35
Q

What are the features of intrinsic muscle wasting of the foot in diabetic foot?

A

Clawed, hammer toes

36
Q

What is per planus?

A

Flat foot

37
Q

What is pes caves?

A

High arch in the foot

38
Q

What is included in the general palpation of diabetic foot?

A
  • Bones and joint of the ankle & foot for swelling + tenderness
  • Watch the patient’s face for discomfort
39
Q

What is included in the vascular palpation of diabetic foot?

A
  • Temperature
  • Pulses
  • Capillary refill
40
Q

How do you assess the temperature of the feet in a diabetic foot exam?

A
  • Using the back of the hands, compare the shins to feet bilaterally
  • Should decrease slightly as you move distally
41
Q

What is a normal temperature pattern of the feet in a diabetic foot examination?

A

The lower limbs should be symmetrically warm, suggesting adequate perfusion

42
Q

What does a cool and pale limb indicate?

A

Poor arterial perfusion

43
Q

What are the 4 pulses which may be tested in a diabetic foot examination?

A
  • Femoral
  • Popliteal
  • Posterior tibial
  • Dorsalis pedis
44
Q

How is the posterior tibial pulse tested in a diabetic foot examination?

A
  • Can be located posterior to the medial malleolus of the tibia
  • Palpate the pulse to confirm its presence and then compare pulse strength between the feet
45
Q

How is the dorsals pedis pulse tested in a diabetic foot examination?

A
  • Can be located over the dorsum of the foot, lateral to the extensor hallucis longus tendon, over the second and third cuneiform bones
  • Palpate the pulse to confirm its presence and then compare pulse strength between the feet
46
Q

What are the two main components of the neuro examination in diabetic foot?

A
  • Reflexes

- Sensation

47
Q

What reflex is tested in a diabetic foot patient and how is it done?

A
  • Ankle jerk reflex
  • Get the leg so the knee is slightly bent and the foot is facing outwards
  • Tap the Achille’s tendon and see if there is plantar flexion of the foot
48
Q

What is the myotome of the ankle-jerk reflex and what may its absence show?

A
  • S1

- Advanced peripheral neuropathy

49
Q

How is sensation with a monofilament tested in a diabetic foot exam?

A
  • Allow them to feel the sensation on their arm

- Place on the inside of the big toe, the inside of the third digit & Metatarsophalangeal joint 1, 3 & 5

50
Q

What should you avoid when using monofilaments in a diabetic foot exam?

A

Calluses and scars as they have a reduced level of sensation

51
Q

How is proprioception of the feet assessed in the diabetic foot exam?

A
  • The upwards and downwards (movement of the joint and get the patient to tell you which way it went) test of the interphalangeal joint of the big toe
  • If they can’t assess it = sequentially assess the more proximal joints
52
Q

How do you assess the neurological exam of the diabetic foot exam using vibration?

A
  • Ask the patient to close their eyes
  • Test the tuning fork on their sternum first so they known when it begins/ends
  • Place on the interphalangeal joint of the patient’s big toe.
  • Continue up sequentially if they can’t identify on the toe
53
Q

What are the different ways to test sensation on a diabetic foot exam?

A
  • Monofilament
  • Light touch (with cotton wool)
  • Pressure
  • Pin prick
  • Temperature
  • Proprioception
  • Vibration
54
Q

Name 7 further examinations/imaging/investigations after a diabetic foot examination

A
  • Bedside capillary blood glucose
  • Serum HbA1c
  • Lower limb neurological examination
  • Peripheral arterial examination
  • Venous examination of the lower limbs
  • Foot care advice
  • Calculation of diabetic foot risk using assessment tool

Phase 2b Medicine (17 decks)

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