PACA II DIABETIC FOOT EXAM QUESTIONS AND ANSWERS

Diabetics may suffer from multiple co-morbidities peripheral neuropathy peripheral vascular insufficiency chronic infections poor wound healing foot deformities (charcot foot, bunions, callouses) Injury or ulceration process in diabetics injury/ulceration--> infection--> increased blood sugars--> poor wound healing--> increased severity of infection--> amputation OR infection & repeat process Hx questions to ask to assess for diabetes any numbness or tingling in your feet? do your shoes fit well? do you look at your feet everyday? any redness in your feet when you take off shoes? do you walk around home or outside w/o shoes? any color changes/thickening of toenails? feet itch? any cramping your legs when you walk? have you stubbed your feet? any wounds not healing well? When do we do a diabetic foot exam? upon diagnosis of diabetes annually, high risk (quarterly), every visit (every 3 months) Annual diabetic foot exam comprehensive diabetic foot exam: skin, musculoskeletal, vascular, and neurological exam High risk patients should have exam quarterly previous hx of ulceration or amputation smokers pts w/ peripheral vascular disease, severe neuropathy, or with foot deformities Every visit (every 3 months)____ diabetics should have a basic foot exam ALL; inspection, monofilament testing (skin exam) Inspect lower extremities for: color, hair distribution, fissures, ulcerations, callouses, maceration, nails, skin thinning, loss of hair of distal LE, hyperpigmentation or "purplish" hue of skin Musculoskeletal exam inspect for bony deformities: bunions (hallux valgus), hammertoes, charchot's foot (multiple fractures w/ cont walking deforms foot) palpate for tenderness over bony prominences Vascular exam look at hair distribution over LE cyanosis of digits & LE pulses (LE, compare bilateral) cap refill distal digits (3-5sec) ABI index (grade severity) edema (unilateral/bilateral and grade) temp (compare bilaterally) Neurological exam vibratory sensation- 128Hz tuning fork positional sensation microfilament- 10g achilles reflex Gait exam look at patterns of shoe wear watch pt walk: wide stance= imbalance, foot drop= neurological conditions shoes for proper size & fit: draw pts bare foot on towel & place shoes over, & look at foot for areas where foot rubs for redness, indentations F/up instructions - have pt to look at feet everyday including bottom of feet - report any new ulcerations, callouses, blisters immediately - wash & dry feet daily w/ mild soap - moisturize dry feet but NO lotion b/w toes - keep toenails trimmed - always wear shoes & socks w/ well-fitting closed toe shoes - check blood sugars regularly - refer to podiatry for bony abnormalities, mod to severe neuropathy for fitting of diabetic shoes