Diabetic Foot Examination Flashcards
Outline the 8 stages of a diabetic foot examination
- Introduction
- General inspection
- Gait
- Leg inspection
- Legs- palpation
- Legs- sensory
- Legs- motor & reflex
- Complete the examination
What equipment will you need for a diabetic foot examination?
- Monofiliament
- Tuning fork (128Hz)
- Neurotip
- Tendon hammer
What should you do in the introduction stage of your diabetic foot examination?
- Wash hands
- Introduce yourself
- Check identity
- Consent
- Ask if in any pain
- Expose
- Position
What should you do in the general inspection stage of your examination?
Inspect Pt
- Look comfortable
- Body habitus
- Amputations
- Dressings/ulcers
- Scars
- Skin colour
- Hair loss
Inspect surroundings
- Walking aids
- Orthotics
- CHECK INSIDE SHOE!
- Insulin/medications
What should you do in the gait section of your diabetic foot examination?
Ask pt to walk to end of room, turn around, and walk back. Inspect for:
- Speed
- Stance (broad stance associated with advanced peripheral neuropathy- pt trying to increase stability)
- Steps (high stepping gate due to foot drop)
- Turning (do they look at their feet due to impaired proprioception & sensation)
THEN ASK TO GET ON BED AND CHECK THE INSIDES OF THEIR SHOES for asymmetrical wearing, materiasl which could cause harm..
What should you do in the leg inspection stage of your diabetic foot examination?
Can split signs you are looking for into: ischaemic associated, diabetic associated, neuropathy associated. ENSURE TO CHECK BETWEEN TOES & UNDER HEAL
Ischaemic associated
- Cyanosis
- Pallor
- Ulcers
- Pressure sores
- Hair loss
- Gangrene
- Scars for vein harvesting/bypass surgery
- Amputations
Diabetes associated
- Necrobiosis lipoidica
- Vitligo
- Granuloma annulare
- Xanthomata
Neuropathy associated
- Calluses
- Foot arch changes
What should you do in the leg palpation stage of your diabetic foot examination?
- Assess temperature
- Cap refill
- Pulses
- Dorsalis pedis
- Posterior tibial
- …. if these absent work up leg until pulse if found
Leg sensation stage of your diabetic foot examination can be broken down into 4 subsections: state these
- Fine touch (DCML)
- Proprioception (ST)
- Vibration (DCML)
- Pin-prick sensation/pain (ST)
What should you do in the fine touch subsection of the leg sensation stage of your diabetic foot examination?
- First, use monofilament to touch pts sternum so they know what it should feel like
- Ask pt to close eyes and test 5 plantar high risk areas- asking pt to tell you when they feel it:
- Pulp of hallux
- Pulp of 3rd digits
- Metatarsophalangeal joints 1, 3 and 5
- If fine touch absent move more proximally until it is intact
***Tips for monofilament: press it on skin until tip bends slightly (ensures 10g of pressure applied), hold against skiin for 1-2 seconds, avoid calluses or scars.
What should you do in the proprioception subsection of the leg sensation stage of your diabetic foot examination?
- Hold pt’s interphalangeal joint of great toe at either side
- Hold pt’s distal phalanx of great toe at either side (NOT on above and below nail as this can skew results)
- Demonstrate ‘up & down’ movement to pt
- Ask them to close their eyes
- Move pt’s toe and ask them to state the direction of movement. Do 3/4 random movements
If pt unable to identify direction of movement, work proximally until they can e.g. ankle, knee
What should you do in the vibration subsection of the leg sensation part of your diabetic foot examination?
- Twang tuning fork between fingers and then place on pt’s sternum to let them know how it should feel
- Ask pt to close eyes
- Palce vibrating tuning fork on interphalangeal joint of great toe
- Ask pt to identify when vibration has stopped
- If unable to identify move more proximally (metatarsophalangeal joint great toe, medial malleolus, tibial tuberosity, greater trochanter, ASIS)
What should you do in the spinothalamic subsection of your leg sensation stage of your diabetic foot examination
- Calibrate neurotip on pts sternum: blunt end and sharp end
- Ask pt to close their eyes and tell you if sensation is sharp or blunt
- ONLY use sharp side; test at most distal end of dorsum of foot
What should you do in the motor & reflex stage of your diabetic foot examination?
- Offer to assess power in lower limbs
- Offer to assess ankle jerk reflexes
- Slightly abduct hip, flex knee and dosiflex ankle
- Support leg by holding mid foot
- Tap achilles tendon with tendon hammer
- Observe for associated plantar flexion of foot (S1)
What should you do in the completing your examination stage of the diabetic foot examination?
- Thank patient
- Wash your hands
- Summarise
- Further assessments & investigations:
- Capillary glucose
- HbA1c
- Lower limb neurologial examination
- Peripheral arterial examination
- Foot care advice
