Diabetic foot physical examination: Difference between revisions
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===Extremities=== | ===Extremities=== | ||
====Inspection==== | ====Inspection==== | ||
The following list is a summary of possible findings in [[diabetic foot]] inspection: | The following list is a summary of possible findings in [[diabetic foot]] inspection:<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><ref name="Wagner1987">{{cite journal|last1=Wagner|first1=F William|title=The Diabetic Foot|journal=Orthopedics|volume=10|issue=1|year=1987|pages=163–172|issn=0147-7447|doi=10.3928/0147-7447-19870101-28}}</ref> | ||
*Peeling [[skin]], [[maceration]], [[fissure|fissuring]] between [[toe|toes]] | *Peeling [[skin]], [[maceration]], [[fissure|fissuring]] between [[toe|toes]] | ||
*Dilated or [[varicose veins]] | *Dilated or [[varicose veins]] | ||
| Line 62: | Line 62: | ||
**[[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. | ||
*Brittle or broken [[nail]] | *Brittle or broken [[nail]] | ||
*[[fungi| | *[[Infection]] | ||
**Such as [[fungi|fungal]] [[infection]] | |||
**Presence of [[pus]] or at least two of the following is indicative of [[infection]]: | |||
***[[Erythema|Redness]] | |||
***[[Pain]] | |||
***Warmth | |||
***Delayed [[wound healing]] | |||
***[[edema|Swelling]] | |||
***Bad [[odor]] | |||
*[[Foot]] deformities such as [[charcot joint|charcot foot]] and [[hammer toe]] | *[[Foot]] deformities such as [[charcot joint|charcot foot]] and [[hammer toe]] | ||
*Pink [[skin]] | *Pink [[skin]] | ||
Revision as of 07:08, 29 June 2021
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Diabetic foot Microchapters |
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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
The following list is a summary of possible findings in diabetic foot inspection:[3][4]
- Peeling skin, maceration, fissuring between toes
- Dilated or varicose veins
- Scar
- Sinuses
- Shiny skin
- Decreased hair distribution
- Areas of pigmentation or discoloration
- Ulcers
- Ulcers in the areas under pressure such as base of the toe or the fifth metatarsus and posterior aspect of heel.
- Brittle or broken nail
- Infection
- Foot deformities such as charcot foot and hammer toe
- Pink skin
- Even in ischemic settings due to arteriovenous shunting.
Palpation
The following is a list of recommended examinations in a diabetic foot patients:[3]
- Temperature
- Increased temperature could be due to deep vein thrombosis while decreased temperature could be an ischemia presentation.
- Due to arteriovenous shunting the involved area may feel warm even in presence of ischemia.
- 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.
- Note that dorsalis pedis and posterior tibial pulses are absent in 8% and 3% of normal population, respectively.
- Capillary filling time (venous refilling > 5s)
- Muscle strength and tone
- Pinprick discrimination and tactile sensation test (use a cotton wool to examine)
- Vibration test (use a 128 Hz-tuning fork)
- Pressure perception test (use a 10-gram (5.07) Semmes––Weinstein monofilament)
- 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.
- ↑ 3.0 3.1 3.2 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.
- ↑ Wagner, F William (1987). "The Diabetic Foot". Orthopedics. 10 (1): 163–172. doi:10.3928/0147-7447-19870101-28. ISSN 0147-7447.