Diabetic foot

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)

• infection (local swab, blood culture, radiograph, MRI).

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Diabetic foot

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