The Diabetic Foot Examination - Podcast Version 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x OSCE Checklist for The Diabetic Foot Examination Introduce yourself to the patient Wash your hands Briefly explain to the patient what the examination involves Always start with inspection and proceed as below unless instructed otherwise; be prepared to be instructed to move on quickly to certain sections by the examiner. Inspection Ask patient to go for a short walk, assessing their gait Difficulty walking or antalgic gaits can assess psychosocial implications of any diabetic foot disease Ask patient to remove socks and shoes, and lie flat on the bed Assess patients shoes, looking for uneven or excessive wearing on soles or heels Assess for symmetry, scarring, deformity, skin changes, or ulcers Important to check between the toes and on the heels for any hidden ulcers or gangrene Any Charcot’s Neuropathy will present with potential deformity (classically a ‘rocker sole’ foot) and erythematous By Medicalpal [CC-BY-SA-3.0], via Wikimedia Commons Figure 1A Charcot Foot Deformity, with associated neuropathic ulcer visible on the medial side Assessment Feel peripheral pulses Check dorsalis pedis and posterior tibial pulses Assess capillary refill (an increased refill time is >2 seconds) Check the temperature of the lower limbs Start from the hip and work distally on both sides Assess sensation in the limbs, asking patient to close their eyes and start distally and working proximally Assess soft sensation with a cotton wool ball or a 10g monofilament Assess sharp sensation with a neurotip If no sensation present, move more proximally in the lower limb Check vibration sensation in the limb using a 152Hz tuning fork Place tuning fork on bony prominences, on the end of the big toe If no vibration sense, place on more proximal bony prominences Check for an ankle jerk reflex Completing the Examination Remember, if you have forgotten something important, you can go back and complete this. To finish the examination, stand back from the patient and state to the examiner that to complete your examination, you would like to perform a: Capillary blood glucose measurement Peripheral vascular examination Urine dipstick Fundoscopy Frequent questions What is the purpose of a diabetic foot examination? The diabetic foot examination aims to assess the patient's foot health, identifying potential complications such as ulcers, deformities, and neuropathy. This examination helps to prevent serious conditions that can arise from diabetes-related foot issues. How do you assess sensation during a diabetic foot examination? Sensation is assessed by asking the patient to close their eyes while testing soft sensation with a cotton wool ball or a 10g monofilament, and sharp sensation with a neurotip. If sensation is absent, the examiner moves proximally to evaluate further. What signs should be looked for during the inspection phase of a diabetic foot examination? During the inspection, signs such as scarring, skin changes, deformities, and ulcers should be noted, along with checking for any uneven wear on the patient's shoes. Special attention should be given to areas between the toes and on the heels for hidden ulcers or gangrene. How do you check for peripheral pulses in a diabetic foot examination? Peripheral pulses are checked by palpating the dorsalis pedis and posterior tibial pulses, while also assessing capillary refill time. An increased refill time of over two seconds may indicate vascular issues. What additional tests should be performed to complete the diabetic foot examination? To complete the examination, it is essential to perform a capillary blood glucose measurement, a peripheral vascular examination, a urine dipstick test, and fundoscopy. These tests provide a comprehensive overview of the patient's diabetic condition and related complications. Rate This Article