Assessment of DM and diabetic foot

 Subjective assessment of DM
 Wound examination
 Sensory assessment of diabetic foot
Dr.Nidhi Ahya(MPT-Cardio-Vascular & PulmonaryPT) 2

 Demographic Data:
 Age: for age of onset of DM
>40 or <40
 Gender: Equally effects both sexes
 Occupation: Sedentary Lifestyle
 Chief Complaint:
 Symptoms of Hypoglycemia or Hyperglycemia
 Associated complains due to complications of
DM
 Sometimes asymptomatic in children- presence
of bed wetting, dehydration, weight loss etc can
be early markers
3Dr.Nidhi Ahya(MPT-Cardio-Vascular & PulmonaryPT)

 History of Presenting Ilness:
 Onset- Age of onset
 Duration- Long term means more complications
 Severity- Recent Random Plasma Glucose level
or glycated Hb levels (HbA1c)
Normal Range- 4% to 5.6%
HbA1c > 8% suggests poor glycemic control
 Preceding event- viral infection, pregnency
 Course of disease- Rx taken since diagnosis
Control of blood sugar
 Associated complains
Poor healing, presence of foot deformities, ulcers

 Past Medical History:
 K/c/o HTN,IHD,PVD and no.of years since
present
 Drug history and response to Rx
 Any known drug allergy
 Hospitalizations
 Past Surgical History:
 LL Amputations
 Family History:
 Genetic Pre-disposition
 The strongest gene, IDDM1 is located in the
HLA Class II region on chromosome 6,
increase the risk of characteristic type 1 DM

 Personal History:
 Diet- timming of food intake,quantity,food habits in
detail
 Bowel/Bladder Habits
 Smoking/Alchohol
Higher rates of retinipathy and neuropathy in patients
of DM who are smokers
 Socio-economic & Environmental History
 Occupational History:
Job stress and no. of working hours
Stress stimulates glucolysis and increases the plasma
glucose concentration in order to prepare the body to
cope up

 General Observation:
 Consciousness, orientation
 Appearance
 Body Type/Built
 Posture
 Documentation of Vitals
 Systemic Overview/Local Inspection
 Head- Eyes: Rubeosis iridis
occurs in advanced retinopathy
Fundoscopic Examination
Visual Acuity

 Forehead and Nose bridge- Xanthelasma
It is a sharply demarcated yellowish deposit of
fat underneath the skin
Indicates high cholesterol levels
Found commonly in obese, diabetic patients

 Neck- Posteriorly for presence of Acanthrosis
Nigrans – brown to black, poorly defined, velvety
hyperpigmentation of skin
 Other sites- back,face,armpits

 Upper Limbs
• Lateral arm for injection marks
• Comparing B/L arms for girth and symmetry
• Muscle wasting
• Limited Joint Mobility

 The development of tight, waxy
skin, probably as a result of
glucose related alteration of
collagen structure, leads to some
limitation of joint mobility.
 Development of fixed curvature of
the fingers which may typically be
seen in some patients with long-
term diabetes.
 Those affected are unable to place
the palm of the hand on a flat
surface- Positive Prayers sign

 Lower Limbs
Necrobiosis is an uncommon
and unsightly blemish of the skin
which chiefly affects diabetic
women.
The shin is the most common
site.
 The lesions show rather
atrophic skin at the centre with
obviously dilated capillaries
(telangiectasis) and a slightly
raised pinkish rim; ulceration
sometimes occurs.
 The lesions are
indolent and rarely resolve

 Development of fatty lumps at
the Injection sites on anterior
thigh
 Examination of the foot
 Deformity
 ulcers
 hammer toes
 loss of archers
 Charcot foot
 Texture of skin
 Integrity of skin
 Texture of nails
 Quality of subcutaneous tissue
 Presence of hair

Cause e.g. Minor trauma
Duration More than 4 weeks is considered chronic
Main
symptom
Pain, Discharge,….
Course •Increasing in size or depth
•Became painful (infected?)
•Discharging (infected?)
•Recurrent (healing & breaking down)
Similar ulcer (same site or elsewhere)
Foot Ulcers
Dr.Nidhi Ahya(MPT-Cardio-Vascular & PulmonaryPT)

Examination
Site Shape Size
Floor
Edge
Depth
Discharge
Base
FloorEdge
Base
Depth

 Floor of the ulcer
It is the part showing loss of tissue, exposing
underlying tissues- bone in severe cases
• Pale and anemic with water discharge- static or
unhealing
• Green or yellowish – infected ulcer
• Pink, bubbly with red spots is granulating ulcer

 Depth the ulcer
• Wagner’s Classification

 Edges of an Ulcer:
• Flat slopping edges- epithelium growing in from
the ulcer edge so it is healing
• Punched out (Square-cut)- indicates rapid death
of whole thicknesss of skin, and usually caused
by stress or trauma on an insensate skin
• Well defined,straight ,red,shiny- spreading ulcer

 Base of an Ulcer:
• Area surrounding the ulcer
• to look for skin color, texture autonomic
changes around the ulcer
• idea about rate of healing process

 Size of an Ulcer:
• Important to calculate the surface area
• Methods:
 Measuring tape
 Cellophane tracing
 Planimeter
 Simple Photography
 Computer Software

 Keep the tracing of the
wound on the graph
paper, roughly
estimate the no. of
squares or do a area
approximation
Here constant
Π= 3.14
l
b

24
Planimeter
• The planimeter is an
instrument used to measure
the area of a flat surface
bounded by a closed
contour.
• Several types of planimeter
are available-
linear planimeter and the
polar planimeter, which
serve to calculate the areas
of flat surfaces, the
planimeter spherical with
which it determines the area
of a spherical surface

25

 Palpation:
 Ulcer boundary for tenderness- Grading
 Pliability
 Adherence to the underlying structures
 Presence of edema in the base of the ulcer-
Grading

 Sensory Assessment
 Touch- Monofilament
testing
 Temperature
 Vibratory sense
(128Hz tuning fork)
 Pain-Pin Prick

 Deformities- Fixed or movable
 Goniometric ROM of involved
joints(AROM+PROM)
 Shoulder ROM – Diabetic patients have higher
chances of development of Frozen Shoulder
• If restriction present- detailed course of
shoulder pain, stiffness
• Capsular Pattern- Abd> ER>Flex> IR>Ad
 Assessment of Muscle Strength
 Functional Assessment- FIM, Barthel Index
 Gait Assessment
 Test for Aerobic capacity

 Subjective assessment of DM
 Wound examination
 Sensory assessment of diabetic foot

1. WRITE THE ASSESMENT OF
DM.5MARKS
2. WRITE THE ASSESMENT OF DIBETIC
FOOT. 5MARKS

Assessment of DM and diabetic foot

Assessment of DM and diabetic foot

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