# Diabetic Foot Examination

## Overview

This module describes how to examine the diabetic foot.

## Indications

Diabetic foot examinations should be performed:

1. Annually in patients with no lower limb complications
2. 3-6 monthly in patients with loss of protective sensation

## Contraindications

1. None

## Patient information and consent

Always verify your patient’s identity and obtain informed consent before proceeding.

### How do I explain this procedure?

“People with diabetes often get problems with their feet such as numbness, injuries and infections. I’m going to examine your feet to ensure yours are healthy.”

### What can my patient expect?

“I’m going to take a good look at your feet, even between your toes, and I’m going to test your foot’s blood circulation and sense of touch.”

### What is my patient’s role?

“Please take off your socks and shoes. Tell me if anything is painful during the examination. Please remind your health care practitioner to check your feet regularly. You can also do it daily at home, or if you are unable to see properly, ask a caregiver to assist. If you have a regular caregiver, ask them to come with you to your next appointment to learn how to do it. I can also give you information on how to look after your feet to prevent problems developing.”

## Preparation

Prepare your equipment.

### Documentation

### Equipment

1. Alcohol-based hand rub
2. Non-sterile gloves if required
3. A 10 g monofilament
4. A tuning fork
5. A blood pressure cuff & stethoscope (or an automatic blood pressure monitor)
6. A Doppler probe

## Site & Positioning

This examination is best performed with the patient reclining, with their feet within easy reach. When testing with the monofilament, place a sheet or towel over the patient’s lower legs and the dorsum of the feet so that the patient cannot see the site.

## Procedure

Follow medical asepsis with non-sterile gloves.

## Troubleshooting

I don’t have a Doppler probe.

Use a stethoscope instead of a Doppler probe. If your institution has a midwife obstetric unit (MOU), they might have a handheld Doppler probe you can borrow.

## Risks

1. None

## References

1. Boulton AJ, Armstrong DG, Albert SF, Frykberg RG, Hellman R, Kirkman MS, et al. Comprehensive Foot Examination and Risk Assessment. Diabetes Care. Aug 2008;31(8):p 1679-1685.
2. Mishra SC, Chhatbar KC, Kashikar A, Mehndiratta A. Diabetic foot. BMJ. 2017;359:j5064.
3. Carmo GA, Mandil A, Nascimento BR, Arantes BD, Bittencourt JC, Falqueto EB, et al. Can we measure the ankle–brachial index using only a stethoscope? A pilot study. Family Practice. 2009;26(1)22–26.