Inspection
General
- gait, shoes, heels,any foot ulcer or deformity.
Skin
- vascular insufficiency - hairlessness, pallor
- rubor at pressure points
- skin breakdown (portal for infections)
- diabetic dermopathy (brown macules) over shins
- infection: cellulitis (erythema, swelling), gangrene
Other
- webspaces: cracked, infected, ulcers, maceration
- toe nails: dystrophic, in-grown, paronychia, Onychomycosis
Palpation
Pulses
- femoral
- popliteal
- posterior tibial
- dorsalis pedis
Temperature
- use back of hand, compare shin to feet, bilaterally
- temperature should decrease slightly as you get toward the toes
Other
- Capillary refill
Auscultation
- Bruits: femoral, popliteal
Neurological
Sensory
- ↓ vibration (1st modality to lose, 128 Hz)
- ↓ light touch (microfilament)
- ↓ pin prick
- ↓ proprioception
- ↓ temperature
- (loss in glove and stocking distribution)
Autonomic
- ↓ sweating
- dry cracked skin
Motor
- intrinsic muscle wasting (clawed, hammer toes)
- Pes planus, Pes cavus
- Charcot joints (medial and laterial deviation at subtalar joint)
Reflexes
- DTR: ↓ ankle jerk
Other OSCE modules
This article is issued from Wikiversity. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.