Diabetic foot examination

Diabetic foot examinationCreated OnApril 18, 2020Last Updated OnApril 19, 2020byadmin You are here: Main Clinical Examination Diabetic foot examination < All Topics Table of Contents Diabetic foot ulcer is extremely common in clinical practice. Approach to short case is slightly different from long cases. In long case, you already collected information from history taking so diagnosis of diabetic foot is almost confirmed. In short case, you need to think of other possibilities of leg ulcer like ischaemic ulcer, venous ulcer, neuropathic ulcer etc. Then, based on the exclusion method, you will finally conclude that the most likely underlying cause will be diabetes. In that sense, to describe the negative relevant finding is crucial. Look Give comments on the site of the ulcer. Use the fix bony reference point, e.g. 2 cm from medial malleolus, 3 cm from the 1st metatarsophalangeal joint. Arterial ulcer is mostly on the tip of the toes and venous ulcer is mostly located above the medial or lateral malleolus and pressure ulcer will be on pressure point like heel, over the medial or lateral malleolus. Traumatic ulcer will be at the sole of the foot, but possible over anywhere around the foot. Comment on the size of ulcer. Normally you do not need to measure using a measuring tape, just estimation is enough. Comment on the shape of ulcer, such as oval, circular or irregular etc. Comment on the margin of ulcer, such as irregular or regular. After wound debridement, most of the margin of the ulcer will be regular. Comment on the edge of ulcer. Normally it should be sloping edge if it is healing ulcer, punch out edges is seen in active ulcer and undermined edges is seen in chronic ulcer. Comment on the floor of ulcer if there is any discharge, blood, pus, necrotic tissue   etc. It is also very important to look condition of the surrounding skin. Check for any pallor or cyanosis to exclude the ischaemic cause. Check for erythema or redness due to infection. Check for any dry shiny skin or hair loss due to neuropathy. Check for any eczema, calluses etc. Look for any edema, discoloration, calf muscle swelling to exclude a venous condition. Look for any deformity e.g. Charcot joint. Sometimes the examiner will ask you the grading of diabetic foot ulcer. There are many grading systems. I would discuss a common one. Look at the two pictures below, would you like to answer their grade? (I would recommend to check your hospital which classification they are using). At the end of the physical examination, you should give your provisional diagnosis using the following grade and give reasons. Feel Feel for temperature. If the temperature is cold, most likely to be ischemia due to peripheral vascular disease and hot most likely to be inflammation or cellulitis. Feel for dorsalis pedis pulse and posterior tibial pulse. Absence of peripheral pulses is sometimes normal variation and cannot conclude as peripheral vascular disease. Check for capillary refill. Feel for any tenderness around foot and ankle. Test for sensation with cotton and pin. Glove and stocking pattern distribution are common in diabetic foot. Do not forget to compare both sides. Test for joint proprioception on metacarpophalangeal joint of big toes. Use the 128 Hz tuning fork to test for vibration. Monofilament test is used over pressure point of sole,...

Continue reading

Please Login/Register to read full article.