Diabetic foot

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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215 Diabetic foot

Instruction

Examine this patient’s legs.

Examine this patient’s feet.

Neuropathic foot

Salient features

History

• Whether there is pain (usually painless neuropathy, but may be painful)

• Whether there is blistering (usually caused by an ill-fitting shoe)

• About a previous history of foot ulcers

• History of diabetes.

Examination

• Dry, warm and pink with palpable pulses

• Impaired deep tendon reflexes

• Reduced pinprick, light touch and vibration sensation

• Ulcers usually painless and plantar.

Ischaemic foot

Salient features

History

• Ask whether there is pain (usually painful)

• Ask about rest pain and claudication

• History of diabetes.

Examination

• Skin is shiny and atrophic with sparse hair

• The foot is cold to touch

• Peripheral pulses are absent (calcified arteries may make pulse examination less reliable)

• Ulcers usually painful and present on the heels and toes

• Check all peripheral pulses.

Neuropathic and ischaemic foot presenting together

Examination

• Ulcer on the foot with callosities at pressure points

• Loss of the arch of foot

• Stocking distribution of sensory loss of all modalities

• Loss of dorsalis pedis and/or posterior tibial pulsations.

Proceed as follows:

• Tell the examiner that you would like to:

• check the urine for sugar
• do a simple neurologic examination of the lower extremities involving the use of a 10 g monofilament to test sensation.

Notes

• When asked to examine the feet, remember that the evaluation should include assessment of:

• degree of neuropathy (clinically)
• severity of ischaemia (clinically, Doppler, CT angiography)
• bone deformity (clinically, radiograph, MRI)
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