Archive:Diabetic Foot Exam

Inspection

General

• gait, shoes, heels

Skin

• vascular insufficiency - hairlessness, pallor
• rubor at pressure points
• skin breakdown (portal for infections)
• diabetic dermopathy (brown macules) over shins
• infection: cellulitis (erythema, swelling), gangrene

Other

• webspaces: cracked, infected, ulcers
• toe nails: dystrophic, in grown, paronychia, Onychomycosis

Palpation

Pulses

• femoral
• popliteal
• posterior tibial
• dorsalis pedis

Temperature

• use back of hand, compare shin to feet, bilaterally

Other

• Capillary refill

Ascultation

• Bruits: femoral, popliteal

Neurological

Sensory

• ↓ vibration (1st modality to loose, 128 Hz)
• ↓ light touch (microfilament)
• ↓ pin prick
• ↓ proprioception
• ↓ temperature
• (loss in glove and stocking distribution)

Autonomic

• ↓ sweating
• dry cracked skin

Motor

• intrinsic muscle wasting (clawed, hammer toes)
• [wikipedia:Pes planus|Pes planus], [wikipedia:Pes cavus|Pes cavus]
• Charcot joints (medial and laterial deviation at subtalar joint)

Reflexes

• DTR: ↓ ankle jerk

Observed structured clinical examination

Acute Confusion - Acute Coronary Syndrome Orders - Anemia - Arterial Blood Gasses - Asthma - Blood Pressure - Chest pain - Chest XRay - CHF - Coma - COPD - Cranial Nerves - Diabetic History - Diabetic Foot - Dysphagia - EKGs - Gallbladder and Liver - Liver Disease - Gait and Balance - Headache - Hematemesis - Hypertension - Jugular Venous Pulses - Knee Exam - Lymph Nodes - Community Acquired Pneumonia - Parkinson Disease - Peripheral Arterial Insufficiency - Pneumonia Examination - Precordial Exam - STD's - Spleen - Swollen Leg Exam - Thyroid Exam - Upper vs Lower Motor Neuron Lesions - Urinary Incontinence