Diabetic Foot Physical Exam

  • WIPE, blah blah 🙂
  • “Take vital signs”
  • Position: laying down 45°
  • Proper exposure: both legs
  • General inspection of the patient + surroundings (walking aids)

 

  • Inspection:
    • Color: pallor\erythema
    • Swelling
    • Joint deformities (Charcot’s joints)
    • PVD: hair loss, shiny skin
    • Infections (between the toes)
      DM foot 1
      Pulses
    • Ulcers (between the toes)
    • Callus (bottom of the feet and heel)
  • Palpation:
    • Temperature
    • Pitting edema
    • Pedal pulses: dorsalis pedis + post tibial
    • Capillary refill (< 2 secs)
  • Sensation: Mono-filament
    • First show the pt how it feels (on back of hands)
    • Ask pt to close their eyes and tell you if they feel on left\right side
  • Vibration: 128 Hz tuning fork
    • First show the pt how it feels (on sternum)
    • Ask pt to close their eye and tell when they feel the vibration + when it stops
    • Place on distal bony prominence
  • Proprioception
    • W\ pt eyes open, show the pt which is up\down
    • Ask pt to close eyes and tell if toe is up\down (hold distal phalanx of great toe by sides)

      DM foot 2
      Mono-filament
  • Reflexes: 
    • Ankle jerk
  • Gait:
    • Smooth
    • Symmetrical
    • Antalgic gait
  • To complete: 
    • Full neurological exam
    • Educate pt on foot care

 


Download the PDF version: here

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