diabetic foot examination
TRANSCRIPT
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DIABETIC FOOT EXAMINATION
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Diabetic Foot Syndrome
Neuropathy PVD Infection
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• DFU and LEA will affect p to 25% of people with diabetes during their life times.
• Three component causes: Neuropathy Foot deformity Minor trauma
(were detected in more than 63% of all ulcer.)
DFU : Diabetic Foot UlcerLEA : Lower Extremity Amputation
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3 divisions of the PNS
DERMAL FISSURESXEROSIS
WEAKNESSABNORMAL ARCHESHAMMARED TOES
STOCKING/ GLOVE DISTRIBUTION
Autonomic Dysfunction
Motor Impairment
Sensory Loss
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Important for clinician to ask the following questions:
1. Does the patient have loss of protective sensation?
2. Is foot deformity present?
3. Does the patient have a history of ulceration, amputation or Charcot foot?
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Foot Inspection For :
• 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
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1- Deformity
• One must examine the foot for bony prominences and deformities.
• 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.
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2- Ulcers :
1. Wound depth:The depth of a wound is much more important for healing than the size of the wound. Wagener Gredes
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2. Wound infection 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.
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3. Ischemic UlcerWound ischemia can be diagnosed by the presence of necrotic tissue or gangrene within a wound, non palpable pulses or confirmatory vascular testing.
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Charcot Foot
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Palpation
• PEDAL PULSE :
– however, the presence of palpable pulses
DOES NOT absolutely exclude peripheral arterial disease.
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• FEMORAL PULSE
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• POPLETEAL
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Buergers Elevation Test
• ELEVATE LIMB UNTIL DORSAL VEINS EMPTIED
• PLANTAR SURFACE OF FOOT TURNS PALE (1 MIN.)
• (IF SEVERE - ? WIDESPREAD INSUFFICIENCY)
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Special Tests
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Monofilament Test:
• The monofilament should be placed against intact skin (without callus) and allowed to buckle.
• 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?”
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Testing 10 sites (plantar to toes and metatarsal heads 1, 3 and 5, plantar midfoot medial and lateral and planter heal , 1st web space
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• The person who cannot feel at least 7 of 10 pedal sites tested is considered to have an absent protective threshold.
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Vibration Test :
A 128 Hz tuning fork can be applied to the tip of the hallux and bony prominences.
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.
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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.
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Ankle Reflex
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The Ankle Brachial Index
systolic ankle pressure systolic arm pressure
ABI =
The ABI is 95% sensitive and 99% specific for PAD.
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• In diabetic patient, the ABI is falsely elevated.
• Can assess the peripheral circulation by measuring the toe systolic pressure (normal > 40 mmHg) using either a strain gauge sensor or photoplethysmography.
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• Transcutaneous oxygen tension (normal > 40 mmHg) measurement has been used as non invasive measurement of limb perfusion.
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Thank You