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)

    

    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)

    

• Reflexes: 
  • Ankle jerk

• Gait:
  • Smooth
  • Symmetrical
  • Antalgic gait

• To complete: 
  • Full neurological exam
  • Educate pt on foot care

Download the PDF version: here