Diabetic_foot+foot_ulcer_exam
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© 2013 Dr Christopher Mansbridge at www.oscestop.com, a source of free OSCE exam notes for medical students’ finals OSCE revision Diabetic Foot / Foot Ulcer Examination Introduction W ash hands, I ntroduce self, ask P atients name & DOB & what they like to be called, E xplain examination and get consent Expose feet Inspection General: gait, shoes (flat heel, pattern of wear) Skin: vascular insufficiency (hair, pallor), rubor/corns/callous at pressure points, texture, fissures, skin breaks/lesions/ulcers, diabetic dermopathy, infection (swelling, erythema, gangrene, cellulitis), oedema, venous eczema/lipodermatosclerosis Nails: dystrophic, ingrown Webspaces: cracked, infected, ulcers, maceration Deformity: claw toes, bony prominency, Charcot’s joints (j oint swelling, collapse of medial longitudinal arch – due to “loss protective pain sensation”) Describe any ulcer: size and site, characteristics (shape, edge, colour), secondary features. Palpation (ARTERIOPATHY) Temperature: use dorsum of each hand to feel up legs Pulses: femoral, popliteal, pos tibial, dorsalis pedis Capillary refill Palpation (NEUROPATHY) Sensory: show patient how each feels on sternum before and get them to close their eyes o Monofilament - use monofilament fully out and use enough force to make it bend. Touch foot in multiple places. o 128Hz Tuning fork - use fingers to twang end with prongs and hold circular base on the patient’s joint. Start over big toe joint first and move proximally if patient can’t feel it. Ask patient to tell you when they feel a vibration, and ask them to say when it stops (manually stop it) o Proprioception - hold distil phalanx of big toe with a finger each side (while stabilising proximal phalanx with other hand). Ask the patient to look and show them the up and down positions. Now, ask them to close their eyes and wiggle up and down a few times, then stop and ask patient if it’s up or down. If no proprioception, move to proximal joints until they can. Motor: muscle wasting, pes planus, pes cavus, Charcot joints Reflexes: ankle jerk Autonomic: sweaty, dry cracked skin To Complete exam Thank patient and cover them “To complete my exam, I would examine do a full neurovascular examination and educate the patient” Summarise and suggest further investigations you would do after a full history o ABPI o Doppler arterial pulses o Blood glucose o HbA1C Venous Ischaemic Neuropathic Site Gaiter region Soles/ pressure areas Depth Superficial Deep Edges Sloping Punched out Base Granulating Sloughy & pale Sloughy & bloody Colour Pink Pale Red Pain Moderate Painful Non-painful Other characteristics May be varicosities, venous eczema, haemosiderin deposits, lipodermatosclerosis Loss of peripheral pulses Sensory neuropathy
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Diabetic foot exam surgery endocrinology OSCE
Transcript of Diabetic_foot+foot_ulcer_exam
-
2013 Dr Christopher Mansbridge at www.oscestop.com, a source of free OSCE exam notes for medical students finals OSCE revision
Diabetic Foot / Foot Ulcer Examination
Introduction
Wash hands, Introduce self, ask Patients name & DOB & what they like to be called, Explain examination and get consent
Expose feet
Inspection
General: gait, shoes (flat heel, pattern of wear)
Skin: vascular insufficiency (hair, pallor), rubor/corns/callous at pressure points, texture, fissures, skin breaks/lesions/ulcers, diabetic dermopathy, infection (swelling, erythema, gangrene, cellulitis), oedema, venous eczema/lipodermatosclerosis
Nails: dystrophic, ingrown
Webspaces: cracked, infected, ulcers, maceration
Deformity: claw toes, bony prominency, Charcots joints (joint swelling, collapse of medial longitudinal arch due to lossprotective pain sensation)
Describe any ulcer: size and site, characteristics (shape, edge, colour), secondary features.
Palpation (ARTERIOPATHY)
Temperature: use dorsum of each hand to feel up legs
Pulses: femoral, popliteal, pos tibial, dorsalis pedis
Capillary refill
Palpation (NEUROPATHY)
Sensory: show patient how each feels on sternum before and get them to close their eyeso Monofilament - use monofilament fully out and use enough force to make it bend. Touch foot in multiple places.o 128Hz Tuning fork - use fingers to twang end with prongs and hold circular base on the patients joint. Start over big
toe joint first and move proximally if patient cant feel it. Ask patient to tell you when they feel a vibration, and ask them to say when it stops (manually stop it)
o Proprioception - hold distil phalanx of big toe with a finger each side (while stabilising proximal phalanx with otherhand). Ask the patient to look and show them the up and down positions. Now, ask them to close their eyes and wiggle up and down a few times, then stop and ask patient if its up or down. If no proprioception, move to proximal jointsuntil they can.
Motor: muscle wasting, pes planus, pes cavus, Charcot joints
Reflexes: ankle jerk
Autonomic: sweaty, dry cracked skin
To Complete exam
Thank patient and cover them
To complete my exam, I would examine do a full neurovascular examination and educate the patient
Summarise and suggest further investigations you would do after a full historyo ABPIo Doppler arterial pulses o Blood glucoseo HbA1C
Venous Ischaemic Neuropathic
Site Gaiter region Soles/ pressure areas
Depth Superficial Deep
Edges Sloping Punched out
Base Granulating Sloughy & pale Sloughy & bloody
Colour Pink Pale Red
Pain Moderate Painful Non-painful
Other characteristics May be varicosities, venous eczema, haemosiderin deposits, lipodermatosclerosis
Loss of peripheral pulses Sensory neuropathy
www.oscestop.com -
2013 Dr Christopher Mansbridge at www.oscestop.com, a source of free OSCE exam notes for medical students finals OSCE revision
Images licensed under Creative Commons Attribution-Share Alike license (sourced from Wikipedia), unless otherwise stated
Neuropathic ulcer Attribution: Creating the Ideal Microcosm for Rapid Incorporation of Bioengineered Alternative Tissues Using An Advanced Hydrogel Impregnated Gauze Dressing: A Case Series. The Foot and Ankle Online Journal 1 (9): 2.
Ischaemic ulcer Used with permission from: Smith & Nephew. Arterial ulcer [online]. Available from: http://www.smith-nephew.com/global/images/other/country/1d3c46d1-9c81-4765-945e-16aad0aa39e2.gif [Accessed 26.06.2013]
