Vascular Exam/Diabetic Foot Exam

Question 1

Components of a diabetic foot examination:

Answer 1

History

Observation
-skin, foot inspection, shoe inspection

Palpation
-temp, pulses, capillary refill

Sensation
-light touch/pressure (eyes closed)
-monofilament testing (5.07 monofilament= 10 grams (protective sensation))
-vibration (eyes closed)
-proprioception (eyes closed)

Gait

Special Testing

Question 2

Common Foot Deformities among individuals with diabetes

Answer 2

Claw toe deformity

bunion and overlapping toes

Rocker bottom deformity secondary to Charcot arthropathy

Question 3

Pulse evaluation:

Answer 3

3+ full, bounding
2+ normal
1+ weak, thread
0 absent

-looking for warmth, color, hair loss, skin lesions, callous

Question 4

What pulses are typically evaluated?

Answer 4

-dorsalis pedis
-posterior tibial
-popliteal

Question 5

How much pressure should you apply for monofilament testing?

Answer 5

just until the monofilament buckles

Question 6

Capillary refill test guidelines:

Answer 6

-press finger/toenail bed until the blood exits and skin blanches

-time in seconds, how quickly normal skin color returns

NORMAL: <3 SECONDS –> longer may indicate arterial deficiency

** only assess tissues and vessels in the digit not more proximal

Question 7

Buerger’s test (2 parts)

Answer 7

1) With the patient supine, elevate both legs to an angle of 45 degrees (this is called the vascular angle). Hold this position for one to two minutes.
—> If poor arterial supply: pallor develops in 30-60 seconds
—> vascular angle of less than 20 degrees indicates severe ischemia

2) Rubor of dependency:
-pt moves from supine to sitting
-Observe the foot, and note a ruddy or purple-red discoloration;
-The “blushing” is termed reactive hyperemia which comes from post-hypoxic vasodilation
-Discoloration is sometimes called “sunset foot’
-More difficult to appreciate in darker skin tones

Question 8

Activity Examination (6MWT) with claudication scale

Answer 8

-use claudication scale
-careful HR, BP, blood glucose and RPE monitoring
-don’t forget the potential for exercise induced hypoglycemia

-record onset of pain and distance walked with pain
-record time walked and distance

Question 9

Claudication Scale:

Answer 9

0- no claudication pain
1-definite discomfort or pain, but only at initial or modest levels (established, but minimal)
2- moderate, bothersome pain
3- intense pain
4- maximal pain, cannot continue

Question 10

Normal and abnormal ABI values:

Answer 10

Normal/acceptable- > 0.91

Mild obstruction - 0.70-0.90 - risk factor assessment and treatment

Moderate obstruction - 0.40-0.69 - refer to vascular specialist

Severe Obstruction - < 0.40
–> refer to vascular specialist, at risk of limb loss (pressure in LE is less than pressure in UE)

HIGHEST SBP IN R FOOT/HIGHEST PRESSURE IN BOTH ARMS = R ABI