Diabetic foot examination
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The document outlines the importance of diabetic foot examinations for high-risk patients to prevent limb and life-threatening issues through early detection. It details signs to look for, including neuropathy, vasculopathy, and deformities, as well as advising on proper footwear and foot care practices. Regular assessments and maintaining good glycaemic control are emphasized to minimize the risk of complications.
Diabetic foot examination
- 1. Diabetic Foot Examination Dr. Chamath Fernando Why is it important? Limb threatening Life threatening Can be salvaged by early detection High Risk Patients 1. Poorly controlledDiabetes 2. Poor compliance 3. Poor hygiene and care 4. History of ulcers 5. Poor eye sight 6. Excessive alcoholabuse and smoking Higher the risk, more frequent should the examinationss be
- 2. Main Issues a. Neuropathy b. Vasculopathy c. Footware d. Eye sight e. Advice Examination Look for Trophic skin changes, purplish colourdue to ischaemia Callosities Ulcers and Gangrene (Trophic?) Hair loss (Vasculitis?) Obviousdeformities e.g. Flat feet, Bunions, Clawing of toes, Charcot’s joints (Later stage), Amputations
- 3. Charcot’s joints Infections (e.g Cellulitis Erythema, Inter digitalspaces Tinea Pedis) Nails:Paronychia, Brown dystrophic nails(in later stages) Feel for Pulses: Dorsalis Pedis and Posterior Tibial (If poorly felt/not felt Refer for ABPI. Normal range is from 0.9-1.2, 0.6-0.9 = Moderate risk, <0.6 is Marked risk of vascular foot ulceration.Unreliable if high values are attributed to calcified arteries) Warmth/coldness, Tenderness (Features of Inflammation) Sensation – Pain (Tooth pick), Light touch (Cotton wool. How to make the wick?), check the sensory level (Glove and Stocking type sensory loss)
- 4. Monofilament-Cause it to bend = 1g =10N (equivalentto 25V in Biothesiometer) If 3 or more points are not felt it is significant sensory impairment and thus the vulnerabilityfor neuropathic ulcers.
- 5. Vibrationsense (128Hz Tuning Fork on tip of the big toe / Ball of the big toe / MedialMalleolus) Joint positionsensation/ Proprioception Ankle reflex (Lost in the latter stages) Examination of footwear Advice on foot-wear Wear always(even indoors) Not too loose or too tight Soft padded Inspect inside before wearing for sand etc No high heals Advice on foot care Examine feet weekly- monthly Wash and keep hygienic, rinse the soap off fully Dry off gently with a towel
- 6. Cut nailshorizontal Use moisturizer id dry skin Consult your doctor if any abnormalitywithout a delay No corn plaster and blades General Advice Good glycaemic control Quit smoking May need referrals for ABPI, Arterial Duplex etc Thank you!