Dr. Chamath Fernando Lecturer, Department of Family Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka.

1. Diabetic Foot Examination
Dr. Chamath Fernando
Why is it important?
Limb threatening
Life threatening
Can be salvaged by early detection
High Risk Patients
1. Poorly controlledDiabetes
2. Poor compliance
3. Poor hygiene and care
4. History of ulcers
5. Poor eye sight
6. Excessive alcoholabuse and smoking
 Higher the risk, more frequent should the examinationss
be

2. Main Issues
a. Neuropathy
b. Vasculopathy
c. Footware
d. Eye sight
e. Advice
Examination
Look for
Trophic skin changes, purplish colourdue to ischaemia
Callosities
Ulcers and Gangrene (Trophic?)
Hair loss (Vasculitis?)
Obviousdeformities e.g. Flat feet, Bunions, Clawing of
toes, Charcot’s joints (Later stage), Amputations

3. Charcot’s joints
Infections (e.g Cellulitis Erythema, Inter digitalspaces
 Tinea Pedis)
Nails:Paronychia, Brown dystrophic nails(in later stages)
Feel for
Pulses: Dorsalis Pedis and Posterior Tibial
(If poorly felt/not felt  Refer for ABPI. Normal range
is from 0.9-1.2, 0.6-0.9 = Moderate risk, <0.6 is Marked risk
of vascular foot ulceration.Unreliable if high values are
attributed to calcified arteries)
Warmth/coldness, Tenderness (Features of Inflammation)
Sensation – Pain (Tooth pick), Light touch (Cotton wool.
How to make the wick?), check the sensory level (Glove
and Stocking type sensory loss)

4. Monofilament-Cause it to bend = 1g =10N (equivalentto
25V in Biothesiometer)
If 3 or more points are not felt it is significant sensory
impairment and thus the vulnerabilityfor neuropathic
ulcers.

5. Vibrationsense (128Hz Tuning Fork on tip of the big toe /
Ball of the big toe / MedialMalleolus)
Joint positionsensation/ Proprioception
Ankle reflex (Lost in the latter stages)
Examination of footwear
Advice on foot-wear
Wear always(even indoors)
Not too loose or too tight
Soft padded
Inspect inside before wearing for sand etc
No high heals
Advice on foot care
Examine feet weekly- monthly
Wash and keep hygienic, rinse the soap off fully
Dry off gently with a towel

6. Cut nailshorizontal
Use moisturizer id dry skin
Consult your doctor if any abnormalitywithout a
delay
No corn plaster and blades
General Advice
Good glycaemic control
Quit smoking
May need referrals for ABPI, Arterial Duplex etc
Thank you!