Diabetic Foot Exam

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

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

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