Diabetic foot physical examination: Difference between revisions
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*Genitourinary [[physical examination|examination]] of [[patients]] with [[diabetic foot]] is usually normal. | *Genitourinary [[physical examination|examination]] of [[patients]] with [[diabetic foot]] is usually normal. | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
*[[Neuromuscular junction|Neuromuscular]] [[physical examination|examination]] of [[patients]] with [[diabetic foot]] is usually normal, except in their [[foot]]. [[physical examination|Examine]] their foot for the following: | *[[Neuromuscular junction|Neuromuscular]] [[physical examination|examination]] of [[patients]] with [[diabetic foot]] is usually normal, except in their [[foot]]. [[physical examination|Examine]] their [[foot]] for the following: | ||
**Motor [[physical examination|examination]] | **Motor [[physical examination|examination]] | ||
***Tone | ***Tone | ||
| Line 40: | Line 40: | ||
***Vibration | ***Vibration | ||
***[[Joint]] position sense | ***[[Joint]] position sense | ||
====Neuropathy Assessment==== | |||
*Using the [[neuropathy]] [[symptoms]] score (NSS) and [[neuropathy]] disability score (NDS) is helpful in [[physical examination]] of [[patients]] with [[diabetic foot]].<ref name="pmid12421436">{{cite journal| author=Meijer JW, Smit AJ, Sonderen EV, Groothoff JW, Eisma WH, Links TP| title=Symptom scoring systems to diagnose distal polyneuropathy in diabetes: the Diabetic Neuropathy Symptom score. | journal=Diabet Med | year= 2002 | volume= 19 | issue= 11 | pages= 962-5 | pmid=12421436 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12421436 }} </ref><ref name="pmid15317601">{{cite journal| author=Daousi C, MacFarlane IA, Woodward A, Nurmikko TJ, Bundred PE, Benbow SJ| title=Chronic painful peripheral neuropathy in an urban community: a controlled comparison of people with and without diabetes. | journal=Diabet Med | year= 2004 | volume= 21 | issue= 9 | pages= 976-82 | pmid=15317601 | doi=10.1111/j.1464-5491.2004.01271.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15317601 }} </ref> | |||
*Findings that favor the [[diagnosis]] of [[neuropathy|sensory neuropathy]]: | |||
**Impaired [[vibration]] perception and [[Proprioception|position sense]] | |||
**Depressed [[Tendon reflex|tendon reflexes]] | |||
*Dull, crushing or cramp-like [[pain]] in the [[bone|bones]] of the [[feet]] | |||
*Sensory [[ataxia]] | |||
*Shortening of the [[achilles tendon]] | |||
*Abnormal thresholds for warm thermal perception | |||
*Decreased neurovascular function | |||
===Extremities=== | ===Extremities=== | ||
====Inspection==== | ====Inspection==== | ||
| Line 59: | Line 69: | ||
*[[Capillary]] filling time | *[[Capillary]] filling time | ||
*[[Ulcers]] in the areas under pressure such as base of the [[toe]] or the fifth [[metatarsus]] and posterior aspect of heel | *[[Ulcers]] in the areas under pressure such as base of the [[toe]] or the fifth [[metatarsus]] and posterior aspect of heel | ||
*[[Muscle strength]] and tone | |||
*[[Sensation]] | |||
*Light touch | |||
*Filament nerve conduction studies | |||
*Quantitative sensory testing and autonomic testing | |||
===Video: Physical Examination Diabetes=== | ===Video: Physical Examination Diabetes=== | ||
Revision as of 06:18, 26 June 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]
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Overview
Physical Examination
Appearance of the Patient
- Patients with diabetic foot ulcer could appear ill developed ulcers.
Vital Signs
- ±Fever (Base on infection severity can present as high or low grade fever)
- Hypothermia or hyperthermia may be present
- Tachycardia
- Low blood pressure could be seen in septic patients
Skin
- Skin examination of patients with diabetic foot is usually normal, except for the foot skin.
HEENT
- HEENT examination of patients with diabetic foot is usually normal.
Neck
- Neck examination of patients with diabetic foot is usually normal.
Lungs
- Pulmonary examination of patients with diabetic foot is usually normal.
Heart
- Cardiovascular examination of patients with diabetic foot is usually normal.
Abdomen
- Abdominal examination of patients with diabetic foot is usually normal.
Back
- Back examination of patients with diabetic foot is usually normal.
Genitourinary
- Genitourinary examination of patients with diabetic foot is usually normal.
Neuromuscular
- Neuromuscular examination of patients with diabetic foot is usually normal, except in their foot. Examine their foot for the following:
- Motor examination
- Tone
- Power
- Reflexes
- Sensory examination
- Vibration
- Joint position sense
- Motor examination
Neuropathy Assessment
- Using the neuropathy symptoms score (NSS) and neuropathy disability score (NDS) is helpful in physical examination of patients with diabetic foot.[1][2]
- Findings that favor the diagnosis of sensory neuropathy:
- Impaired vibration perception and position sense
- Depressed tendon reflexes
- Dull, crushing or cramp-like pain in the bones of the feet
- Sensory ataxia
- Shortening of the achilles tendon
- Abnormal thresholds for warm thermal perception
- Decreased neurovascular function
Extremities
Inspection
- Peeling skin, maceration, fissuring between toes
- Dilated or varicose veins
- Scar
- Sinuses
- Shiny skin
- Hair distribution
- Areas of pigmentation or discoloration
- Ulcers
- Brittle or broken nail
- Fungal infection
- Foot deformities such as charcot foot and hammer toe
Palpation
- Temperature (increased temperature could be due to deep vein thrombosis while decreased temperature could be an ischemia presentation)
- Tenderness (squeeze calf muscle and achilles tendon for tenderness)
- Pulses such as dorsalis pedis
- Capillary filling time
- Ulcers in the areas under pressure such as base of the toe or the fifth metatarsus and posterior aspect of heel
- Muscle strength and tone
- Sensation
- Light touch
- Filament nerve conduction studies
- Quantitative sensory testing and autonomic testing
Video: Physical Examination Diabetes
{{#ev:youtube|715j6zRZHaA}}
Image: Diabetic Foot Ulcer
References
- ↑ Meijer JW, Smit AJ, Sonderen EV, Groothoff JW, Eisma WH, Links TP (2002). "Symptom scoring systems to diagnose distal polyneuropathy in diabetes: the Diabetic Neuropathy Symptom score". Diabet Med. 19 (11): 962–5. PMID 12421436.
- ↑ Daousi C, MacFarlane IA, Woodward A, Nurmikko TJ, Bundred PE, Benbow SJ (2004). "Chronic painful peripheral neuropathy in an urban community: a controlled comparison of people with and without diabetes". Diabet Med. 21 (9): 976–82. doi:10.1111/j.1464-5491.2004.01271.x. PMID 15317601.