Foot Examination - Appendix
Foot examination - Checking your risk of developing a diabetic foot ulcer
There are so many risk factors, which is the worst ?
Severe peripheral vascular disease is probably the worst. Much less trauma is required to cause damage when the blood supply is poor. Any damage will not heal well. This is why it is so important to refrain from smoking.
When should ankle brachial index be measured ?
It should be measured when the foot pulses are not clearly palpable. It should also be measured when an ulcer is not healing. This helps decide how much of this failure to heal is due to poor vascular supply. This will in turn help to decide if vascular intervention such as angioplasty or by-pass surgery is required. If foot pulses are weak, ankle brachial index should also be measured to see if it is safe to debride the wound.
When should toe pressure be measured ?
Toe pressure should be used instead of ankle brachial index if the ankle arteries are calcified, as shown by an ankle brachial index greater than 1.2. Calcification of arteries makes the ankle brachial index unreliable. This is particularly common in diabetic patients with long duration of diabetes, severe neuropathy and kidney disease. In these people it is also safer to measure the toe pressure as well.
How should sensation be tested with a monofilament ?
It is worthwhile making sure that the monofilament that is used is a 10 gm one. Different people test different sites. At the RPAH Diabetes Centre, we test it at two sites on the bottom of the feet. If the monofilament cannot be felt at one or both of the sites, then the loss of sensation is considered to be significant.