Foot Exam

Question 1

What are venous ulcers

Answer 1

typically large and shallow ulcers with irregular borders that are only mildly painful. These ulcers most commonly develop over the medial aspect of the ankle.

Question 2

What are arterial ulcers

Answer 2

typically small, well-defined, deep ulcers that are very painful. These ulcers most commonly develop in the most peripheral regions of a limb (e.g. the ends of digits).

Question 3

What is gangrene

Answer 3

tissue necrosis secondary to inadequate perfusion. Typical appearances include a change in skin colour (e.g. red, black) and breakdown of the associated tissue.

Question 4

What is vein guttering

Answer 4

veins that have very little blood within them due to poor blood supply to the limb, hence the “guttered” appearance

Question 5

What is Charcot arthropathy and clinical features

Answer 5

theprogressive degenerationof aweight-bearing jointdue toperipheral neuropathy.
- Effusion
- Distortion
- Overlying erythema
- Loss of joint function

Question 6

What pulses to check on foot exam

Answer 6

Posterior tibial and doralis pedis

Question 7

Where to place monofilament on testing

Answer 7

• The pulp of the hallux.
• The pulp of the third digit.
• Metatarsophalangeal joints 1, 3 and 5.

Question 8

Why should you avoid scars or calluses on monofilament exams

Answer 8

they have a reduced level of sensation that is not representative of the surrounding tissue.

Question 9

What to inspect on patients footwear

Answer 9

• Note the pattern of wear on the soles (asymmetrical wearing may indicate an abnormal gait).
• Check that the shoes are the correct size for the patient.
• Ensure there are no materials within the shoe that could cause foot injury.

Question 10

What dermatome is the ankle jerk reflex

Answer 10

S1

Question 11

Further examinations of a diabetic foot exam

Answer 11

CBG
HbA1c
Lower limb neuro and vascular exam
Peripheral arterial exam
Give foot care advice
Calc of risk using assessment tool - ACT NOW

Question 12

ACT NOW Tool

Answer 12

Diabetic foot
A Recent or history of an accident or trauma?
C Is there any new swelling, redness, change of shape of the foot?
T If there is a change in temperature present? Infection or possible Charcot?
N Is there new pain present? Is it localised or generalised throughout the foot?
O What colour is any exudate (oozing)? Is there any odour?
W document the size, shape and position of the wound in the foot affected?