DIABETIC FOOT EXAMINATION

Hx: First diagnosed with diabetes

PMHx of diabetic emergencies
Management – current medication, control, blood monitoring
Complications – arterial disease, retinopathy, nephropathy, neuropathy,
autonomic neuropathy, feet
MDT – podiatrist, district nurse

INSPECT (BOTH FEET)

- Gross deformities eg. Charcot’s arthropathy, bunion, hammertoe, tailor’s
bunion
- Look closer for hair loss or growth, nail changes, atrophy of intrinsic
muscles
- Skin ulcers? Between toes, on soles, beneath heels, dorsum.
- Patient’s shoes

Ulcers – Size, circulatory function and depth

Condition of surrounding skin eg. Hypertrophy, hyperkeratosis,
infection
Granular, fibrotic or necrotic

PALPATE
- Skin temperature – warm in Charcot
- Pulses – dorsalis pedis, posterior tibialis (move proximally if absent)
-

SENSATION
- Monofilament test for protective sensation
- Tuning fork placed against bony prominences for fibratory sensation
- Sharp and dull neurotip for pain sensation
- Proprioception

MOVE
- Tone
- ROM
- Power
- Reflexes

Management:
Regular chiropody to remove callus
Relieve high-pressure areas with bedrest and/or therapeutic shoes
Treatment for infection of ulcers – benzylpenicillin, flucloxacillin and
metronidazole IV