Diabetic Foot Examination


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Diabetic Foot Examination

  2. 2. Diabetic Foot Syndrome<br />Neuropathy<br />PVD<br />Infection<br />
  3. 3. DFU and LEA will affect p to 25% of people with diabetes during their life times.<br />Three component causes:<br /><ul><li>Neuropathy
  4. 4. Foot deformity
  5. 5. Minor trauma </li></ul>(were detected in more than 63% of all ulcer.) <br />DFU : Diabetic Foot Ulcer<br />LEA : Lower Extremity Amputation<br />
  6. 6. 3 divisions of the PNS<br />stocking/ glove distribution<br />Sensory Loss<br />Weakness<br />Abnormal Arches<br />Hammared Toes<br />Motor Impairment<br />dermal fissures<br />xerosis<br />Autonomic Dysfunction<br />
  7. 7. Important for clinician to ask the following questions:<br />Does the patient have loss of protective sensation?<br />Is foot deformity present?<br />Does the patient have a history of ulceration, amputation or Charcot foot?<br />
  8. 8. Foot Inspection For :<br />Deformity<br />ulcers<br />hammer toes <br />loss of archers<br />Charcot foot <br />Texture of skin<br />Integrity of skin<br />Texture of nails<br />Quality of subcutaneous tissue<br />Presence of hair<br />
  9. 9. 1- Deformity<br />One must examine the foot for bony prominences and deformities. <br />It is important to determine if a deformity is rigid or flexible as rigid deformities are often more difficult to accommodate conservatively and may need surgery.<br />
  10. 10.
  11. 11. 2- Ulcers :<br />Wound depth:<br /> The depth of a wound is much more important for healing than the size of the wound. Wagener Gredes<br />
  12. 12. Wound infection<br /> Wounds are considered infected if they have perulence and/or at least 2 of the following signs and symptoms: pain, warmth, erythema, oedema, lymphangitis or loss of function. <br />
  13. 13. Ischemic Ulcer<br /> Wound ischemia can be diagnosed by the presence of necrotic tissue or gangrene within a wound, non palpable pulses or confirmatory vascular testing. <br />
  14. 14.
  15. 15. Charcot Foot<br />
  16. 16. Palpation<br />Pedal Pulse :<br />however, the presence of palpable pulses DOES NOT absolutely exclude peripheral arterial disease.<br />
  17. 17. Femoral Pulse<br />
  18. 18. Popleteal<br />
  19. 19. Buergers Elevation Test<br />• Elevate limb until dorsal veins emptied<br />• Plantar surface of foot turns pale (1 min.)<br />• (If severe - ? Widespread Insufficiency)<br />
  20. 20.
  21. 21. Special Tests<br />
  22. 22. Monofilament Test:<br />The monofilament should be placed against intact skin (without callus) and allowed to buckle.<br />The patient should have his or her eyes closed during testing and be given a forced choice i.e. asked “ Do you feel the pressure at time A or time B?” <br />
  23. 23.
  24. 24. Testing 10 sites (plantar to toes and metatarsal heads 1, 3 and 5, plantar midfoot medial and lateral and planter heal , 1st web space<br />
  25. 25. The person who cannot feel at least 7 of 10 pedal sites tested is considered to have an absent protective threshold.<br />
  26. 26. Vibration Test :<br /><ul><li>A 128 Hz tuning fork can be applied to the tip of the hallux and bony prominences.
  27. 27. It is important to give a non vibrating stimulus such as touch to verify that the person is giving a positive response to the vibration sense and not just to the touch sensation. </li></li></ul><li>
  28. 28. <ul><li>The vibratory perception threshold (VPT) meter or the biothesiometer can be used to quantify sensory loss and the progression of loss of nerve function by measurements at regular intervals. </li></li></ul><li>
  29. 29. Ankle Reflex<br />
  30. 30. The Ankle Brachial Index<br />systolic ankle pressure <br />systolic arm pressure<br />ABI =<br />The ABI is 95% sensitive<br /> and 99% specific for PAD.<br />
  31. 31. In diabetic patient, the ABI is falsely elevated. <br />Can assess the peripheral circulation by measuring the toe systolic pressure (normal &gt; 40 mmHg) using either a strain gauge sensor or photoplethysmography.<br />
  32. 32.
  33. 33. Transcutaneous oxygen tension (normal &gt; 40 mmHg) measurement has been used as non invasive measurement of limb perfusion. <br />
  34. 34. Thank You<br />