Diabetic foot physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Diabetic foot}} | {{Diabetic foot}} | ||
{{CMG}} {{AE}} {{VVS}} | {{CMG}} {{AE}} {{Anahita}} {{VVS}} | ||
==Overview== | ==Overview== | ||
| Line 9: | Line 8: | ||
==Physical Examination== | ==Physical Examination== | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*[[Patients]] with [[diabetic foot]] [[ulcer]] could appear ill | *[[Patients]] with [[diabetic foot]] [[ulcer]] could appear ill if [[ulcers]] are severe or infected. | ||
===Vital Signs=== | ===Vital Signs=== | ||
*±[[Fever]] ( | *±[[Fever]] (Based on the [[infection]] severity can present as high or low grade [[fever]]) | ||
*[[Hypothermia]] or [[hyperthermia]] may be present | *[[Hypothermia]] or [[hyperthermia]] may be present | ||
*[[Tachycardia]] | *[[Tachycardia]] | ||
| Line 18: | Line 17: | ||
*[[Skin]] [[physical examination|examination]] of [[patients]] with [[diabetic foot]] is usually normal, except for the [[foot]] [[skin]]. | *[[Skin]] [[physical examination|examination]] of [[patients]] with [[diabetic foot]] is usually normal, except for the [[foot]] [[skin]]. | ||
===HEENT=== | ===HEENT=== | ||
* HEENT [[physical examination|examination]] of [[patients]] with [[diabetic foot]] is usually normal. | *HEENT [[physical examination|examination]] of [[patients]] with [[diabetic foot]] is usually normal. | ||
===Neck=== | ===Neck=== | ||
*[[Neck]] [[physical examination|examination]] of [[patients]] with [[diabetic foot]] is usually normal. | *[[Neck]] [[physical examination|examination]] of [[patients]] with [[diabetic foot]] is usually normal. | ||
| Line 41: | Line 40: | ||
***[[Joint]] position sense | ***[[Joint]] position sense | ||
====Neuropathy Assessment==== | ====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> | *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><ref name="pmid22172474">{{cite journal| author=Lepäntalo M, Apelqvist J, Setacci C, Ricco JB, de Donato G, Becker F | display-authors=etal| title=Chapter V: Diabetic foot. | journal=Eur J Vasc Endovasc Surg | year= 2011 | volume= 42 Suppl 2 | issue= | pages= S60-74 | pmid=22172474 | doi=10.1016/S1078-5884(11)60012-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22172474 }} </ref> | ||
*Findings that favor the [[diagnosis]] of [[neuropathy|sensory neuropathy]]: | *Findings that favor the [[diagnosis]] of [[neuropathy|sensory neuropathy]]: | ||
**Impaired [[vibration]] perception and [[Proprioception|position sense]] | **Impaired [[vibration]] perception and [[Proprioception|position sense]] | ||
| Line 66: | Line 65: | ||
*Temperature (increased temperature could be due to [[deep vein thrombosis]] while decreased temperature could be an [[ischemia]] presentation) | *Temperature (increased temperature could be due to [[deep vein thrombosis]] while decreased temperature could be an [[ischemia]] presentation) | ||
*[[Tenderness]] (squeeze [[Tibia|calf]] [[muscle]] and [[achilles tendon]] for [[tenderness]]) | *[[Tenderness]] (squeeze [[Tibia|calf]] [[muscle]] and [[achilles tendon]] for [[tenderness]]) | ||
*[[pulse|Pulses]] such as [[Dorsalis pedis artery|dorsalis pedis]] | *[[pulse|Pulses]] such as [[Dorsalis pedis artery|dorsalis pedis]] and [[Posterior tibial artery|posterior tibial]] [[pulses]] | ||
**Although even when both [[Dorsalis pedis artery|dorsalis pedis]] and [[Posterior tibial artery|posterior tibial]] [[pulses]] are present, low perfusion can not be excluded. | |||
*[[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 | ||
Revision as of 14:50, 28 June 2021
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Diabetic foot physical examination On the Web |
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American Roentgen Ray Society Images of Diabetic foot physical examination |
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Risk calculators and risk factors for Diabetic foot physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2] Vishnu Vardhan Serla M.B.B.S. [3]
Overview
Physical Examination
Appearance of the Patient
- Patients with diabetic foot ulcer could appear ill if ulcers are severe or infected.
Vital Signs
- ±Fever (Based on the 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][3]
- 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 and posterior tibial pulses
- Although even when both dorsalis pedis and posterior tibial pulses are present, low perfusion can not be excluded.
- 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.
- ↑ Lepäntalo M, Apelqvist J, Setacci C, Ricco JB, de Donato G, Becker F; et al. (2011). "Chapter V: Diabetic foot". Eur J Vasc Endovasc Surg. 42 Suppl 2: S60–74. doi:10.1016/S1078-5884(11)60012-9. PMID 22172474.