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Diabetic Foot Examination Ppt

Diabetic Foot Examination

Diabetic Foot Examination

Foot ulcers and other peripheral diabetic complications are common, and associated with high levels of morbidity and mortality. Early detection and preventative management leads to fewer lower limb amputations. Introductions, explanation and consent Wash hands Dermatological Assessment Perfusion- pale, or pink and well perfused? Any areas of discolouration Venous- moderate to large size, no pain Arterial- deep, well demarcated, very painful Fungal or ingrown nails Look all over the foot and ankle Look between the toes- deeper lesions may be missed! Look under the heel Vascular Assessment Temperature of foot Symmetry of temperature Neurological Assessment Patients with neurological loss of protective sensation (LOPS) are at increased risk of unrecognised injury, leading to ulceration and additional complications. During all sensory assessments, first display what your sensation will feel like on the sternum, then ask the patient to close their eyes and tell you when they can feel it and if it feels the same on both sides. Microfilament (don't use a neurotip - may cause break in skin that leads to ulceration) Press the monofilament firmly so that the tip bends, for 1-2 seconds. If a discrepancy is found then perform a sensory level test, i.e. keep touching up the leg until the patient can feel it Test on the sole; big toe (L4), little toe (L5), heel (S1) Place a 128 Hz tuning fork on the first joint of the big toe Rest your index finger lightly on the patients first, third, and fifth toes Observe for deformity e.g. hammer toe, claw toe, charcot neuropathy Inspect the patient's shoes for unusual wear patterns Looking for: Symmetry Balance Foot drop or dragging of feet Reflexes Ankle jerk (S1,2) Proprioception This is less well researched in diabetic foot care, and does not Continue reading >>

Diabetic Ulcers Clinical Presentation: History, Physical Examination

Diabetic Ulcers Clinical Presentation: History, Physical Examination

Author: Vincent Lopez Rowe, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP more... The history should focus on symptoms indicative of possible peripheral neuropathy or peripheral arterial insufficiency. The symptoms of peripheral neuropathy include the following: Symptoms of peripheral arterial insufficiency Most people harboring atherosclerotic disease of the lower extremities are asymptomatic; others develop ischemic symptoms. Some patients attribute ambulatory difficulties to old age and are unaware of the existence of a potentially correctible problem. Patients who are symptomatic may present with intermittent claudication, ischemic pain at rest, nonhealing ulceration of the foot, or frank ischemia of the foot. Cramping or fatigue of major muscle groups in one or both lower extremities that is reproducible upon walking a specific distance suggests intermittent claudication. This symptom increases with ambulation until walking is no longer possible, and it is relieved by resting for several minutes. The onset of claudication may occur sooner with more rapid walking or walking uphill or up stairs. The claudication of infrainguinal occlusive disease typically involves the calf muscles. Discomfort, cramping, or weakness in the calves or feet is particularly common in the diabetic population because they tend to have tibioperoneal atherosclerotic occlusions. Calf muscle atrophy may also occur. Symptoms that occur in the buttocks or thighs suggest aortoiliac occlusive disease. Rest pain is less common in the diabetic population. In some cases, a fissure, ulcer, or other break in the integrity of the skin envelope is the first sign that loss of perfusion has occurred. When a diabetic patient presents with gangrene, it is often the result of infection. Physical examinati Continue reading >>

Diabetic Foot Problems: Prediabetic Foot Problems: Prevvention Andention And Managementmanagement

Diabetic Foot Problems: Prediabetic Foot Problems: Prevvention Andention And Managementmanagement

© NICE 2017. All rights reserved. Subject to Notice of rights (rights). YYour responsibilityour responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Diabetic foot problems: prevention and management (NG19) © NICE 2017. All rights reserved. Subject to Notice of rights (conditions#notice-of-rights). Page 2 of 49 ContentsContents Overview ............................................................................................... Continue reading >>

Five Cornerstones Of The Management Of The Diabetic Foot

Five Cornerstones Of The Management Of The Diabetic Foot

To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video Five cornerstones of the management of the diabetic foot Published by Augusta Griffith Modified over 2 years ago Presentation on theme: "Five cornerstones of the management of the diabetic foot" Presentation transcript: 1 Five cornerstones of the management of the diabetic foot 1. Regular inspection and examination of the foot. 2.Identification of the foot at risk. 3.Education of patient, family and healthcare providers. 4.Appropriate footwear. 5.Treatment of non ulcerative pathology 2 Five cornerstones of the management of the diabetic foot 1. Regular inspection and examination of the foot. 2.Identification of the foot at risk. 3.Education of patient, family and healthcare providers Appropriate footwear Treatment of non ulcerative pathology 3 Regular inspection and examination of the foot All diabetic patients should be examined at first presentation then at least once a year Patients with risk factors should be examined every 1-6 months Absent symptoms does not mean that the feet are healthy Examine the patient on lying down and standing up Shoe and socks should be inspected 4 Foot examination Nails Foot deformity Skin condition Vascular assessment Neurological assessment 5 Foot examination Nails Thick Too long Ingrown Fungal infection 6 Foot Examination Foot deformity: Toe deformity Forefoot deformity Hammer toe Claw toe Forefoot deformity Hallux valgus Hallux rigidus Wholefoot Deformities Pes Cavus - High arched foot Pes Planus - Flat foot Charcot foot 7 Foot Examination Skin condition: Callus Bunions Redness Warmth Fissure Dryness Swelling Maceration Fugal infection 8 Foot Examination Vascular assessment Neurological assessment 10/5/2008 Mansoura DF 2nd I Continue reading >>

Diabetic Foot Infectionsclinical Presentation

Diabetic Foot Infectionsclinical Presentation

Diabetic Foot InfectionsClinical Presentation Author: Michael Stuart Bronze, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP more... As previously mentioned, local trauma and/or pressure (often in association with lack of sensation because of neuropathy), in addition to microvascular disease, may lead to a diabetic foot infection. However, patients may not necessarily have a history of trauma or have suffered a previous infection. Cellulitis may involve tender, erythematous, nonraised skin lesions on the lower extremity that may or may not be accompanied by lymphangitis. Lymphangitis suggests a group A streptococcal etiology. If bullae are present, S aureus is the most likely pathogen, but group A streptococci occasionally cause bullous lesions. No ulcer or wound exudate is present in patients with cellulitis. Patients with deep-skin and soft-tissue infections may be acutely ill, with painful induration of the soft tissues in the extremity. These infections are particularly common in the thigh area, but they may be seen anywhere on the leg or foot. Wound discharge is usually not present. In mixed infections that may involve anaerobes, crepitation may be noted over the afflicted area. Extreme pain and tenderness indicate the possibility of a compartment syndrome. Similarly, extreme pain may be an indication of infection with clostridial species (ie, gas gangrene). The tissues are not tense, and bullae may be present. If a discharge is present, it is often foul. Unless peripheral neuropathy is present, the patient has pain at the site of the involved bone. Usually, fever and regional adenopathy are absent. In chronic osteomyelitis, the patient's temperature is usually less than 102F. Discharge is commonly foul. No lymphangitis is observed, and pain may or may not be pre Continue reading >>

Diabetic Foot Ulcer

Diabetic Foot Ulcer

Diabetic foot ulcer is a major complication of diabetes mellitus, and probably the major component of the diabetic foot. Wound healing is an innate mechanism of action that works reliably most of the time. A key feature of wound healing is stepwise repair of lost extracellular matrix (ECM) that forms the largest component of the dermal skin layer.[1] But in some cases, certain disorders or physiological insult disturbs the wound healing process. Diabetes mellitus is one such metabolic disorder that impedes the normal steps of the wound healing process. Many studies show a prolonged inflammatory phase in diabetic wounds, which causes a delay in the formation of mature granulation tissue and a parallel reduction in wound tensile strength.[2] Treatment of diabetic foot ulcers should include: blood sugar control, removal of dead tissue from the wound, wound dressings, and removing pressure from the wound through techniques such as total contact casting.[3] Surgery in some cases may improve outcomes.[3] Hyperbaric oxygen therapy may also help but is expensive.[3] It occurs in 15% of people with diabetes,[4] and precedes 84% of all diabetes-related lower-leg amputations.[5] Classification[edit] Diabetic foot ulcer is a complication of diabetes. Diabetic foot ulcers are classified as either neuropathic, neuroischaemic or ischaemic.[6] Risk factors[edit] Risk factors implicated in the development of diabetic foot ulcers are infection, older age,[7] diabetic neuropathy, peripheral vascular disease, cigarette smoking, poor glycemic control, previous foot ulcerations or amputations,[5] and ischemia of small and large blood vessels.[8][9] Prior history of foot disease, foot deformities that produce abnormally high forces of pressure, renal failure, oedema, impaired ability to look Continue reading >>

The Diabetic Foot

The Diabetic Foot

Complications in the diabetic foot are mostly caused by a triad of ischemia, diabetic neuropathy, and infection. [1] Statistics about the impact of diabetic foot complications:[1] Foot ulcer complications are the main reason why people with diabetes are hospitalized and have to undergo amputations. 20-40% of all the health care costs comprised for diabetes are for diabetic foot complications 7-10% of patients with diabetes and neuropathy will develop an ulcer; this increases up to 30% for patients with diabetes and other comorbidities. 5-8% of patients will undergo a major amputation 1 year after developing a diabetic ulcer. A foot ulcer preceded 85% of diabetes related amputations. “Diabetes increases the risk of amputation 8-fold in patients aged >45 years,8 12-fold in patients aged>65 years and 23-fold in those aged 65––74 years.” More information on Diabetes is available from these Physiopedia pages: DM Type 2 and DM Type 1, Diabetes Due to diabetic neuropathy patients do not have the protective sensation in their feet. Thus the patient will not feel any trauma, like stepping on something sharp or wearing tight shoes. This could lead to continuous tissue damage, ulceration, foot deformities, increased plantar pressure, and infection. There is a 50% delay in diagnosing deep foot infections in diabetes patients because the infection markers in their blood tests are found absent. [1] Infections in a diabetic foot can rapidly spread to the rest of the body and if not treated properly could lead to a life-threatening general septic infection [1] Also known as Charcot-Marie-Tooth Disease or Diabetic foot arthropathy. They may present with: History General (Medications, diseases, cardiovascular risk factors, work, hobbies, lifestyle, diabetes symptoms/complications Continue reading >>

Inpatient Management Of Diabetic Foot Disorders: A Clinical Guide

Inpatient Management Of Diabetic Foot Disorders: A Clinical Guide

Inpatient Management of Diabetic Foot Disorders: A Clinical Guide We are experimenting with display styles that make it easier to read articles in PMC. The ePub format uses eBook readers, which have several "ease of reading" features already built in. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. Inpatient Management of Diabetic Foot Disorders: A Clinical Guide Dane K. Wukich, MD, David G. Armstrong, DPM, PHD, MD, [...], and Linda Siminerio, RN, PHD The implementation of an inpatient diabetic foot service should be the goal of all institutions that care for patients with diabetes. The objectives of this team are to prevent problems in patients while hospitalized, provide curative measures for patients admitted with diabetic foot disorders, and optimize the transition from inpatient to outpatient care. Essential skills that are required for an inpatient team include the ability to stage a foot wound, assess for peripheral vascular disease, neuropathy, wound infection, and the need for debridement; appropriately culture a wound and select antibiotic therapy; provide, directly or indirectly, for optimal metabolic control; and implement effective discharge planning to prevent a recurrence. Diabetic foot ulcers may be present in patients who are admitted for nonfoot problems, and these ulcers should be evaluated by the diabetic foot team during the hospitalization. Pathways should be in place for urgent or emergent treatment of diabetic foot infections and neuropathic fractures/dislocations. Surgeons involved with these patients should have knowledge and interest in limb preservation techniques. Prevention of iatr Continue reading >>

Diabetic Foot Examination

Diabetic Foot Examination

1. DIABETIC FOOT EXAMINATION 2. Diabetic Foot SyndromeNeuropathyPVDInfection 3. DFU and LEA will affect p to 25% of people with diabetes during their life times.Three component causes:

  • Neuropathy 5. Minor trauma
(were detected in more than 63% of all ulcer.) DFU : Diabetic Foot UlcerLEA : Lower Extremity Amputation 6. 3 divisions of the PNSstocking/ glove distributionSensory LossWeaknessAbnormal ArchesHammared ToesMotor Impairmentdermal fissuresxerosisAutonomic Dysfunction 7. Important for clinician to ask the following questions:Does the patient have loss of protective sensation?Is foot deformity present?Does the patient have a history of ulceration, amputation or Charcot foot? 8. Foot Inspection For :Deformityulcershammer toes loss of archersCharcot foot Texture of skinIntegrity of skinTexture of nailsQuality of subcutaneous tissuePresence of hair 9. 1- DeformityOne must examine the foot for bony prominences and deformities. It is important to determine if a deformity is rigid or flexible as rigid deformities are often more difficult to accommodate conservatively and may need surgery. 11. 2- Ulcers :Wound depth: The depth of a wound is much more important for healing than the size of the wound. Wagener Gredes 12. Wound infection Wounds are considered infected if they have perulence and/or at least 2 of the following signs and symptoms: pain, warmth, erythema, oedema, lymphangitis or loss of function. 13. Ischemic Ulcer Wound ischemia can be diagnosed by the presence of necrotic tissue or gangrene within a wound, non palpable pulses or confirmatory vascular testing. 16. PalpationPedal Pulse :however, the presence of palpable pulses DOES NOT absolutely exclude peripheral arterial disease. 17. Femoral Pulse 18. Popleteal 19. Buergers Elevation Test• El Continue reading >>

Model Of Care For The

Model Of Care For The

Diabetic Foot National Diabetes Programme Clinical Strategy and Programmes Directorate 2011 Document Control Revision number: 01 Document drafted by: National Diabetes Programme Working Group Approval date: October 2011 Document approved by: National Diabetes Programme, Clinical Advisory Group of the HSE/RCPI Primary care and local hospitals delivering care for the diabetic foot Responsibility for evaluation and audit: National Diabetes Programme National Diabetes Programme, Clinical Strategy and Programmes Directorate i Contents 1.0 Introduction 1 1.1 Purpose of the Model of Care 1 1.2 Overview 2 1.3 Multidisciplinary Team Member Involvement 3 1.4 Integrated Model of Management/Care Pathway for People with Diabetic Foot Problems 3 2.0 Diabetes Foot Screening 4 2.1 Routine Foot Screening Process 4 3.0 Low Risk Foot (Green) 5 3.1 Foot Examination Frequency 5 3.2 Examiner 5 3.3 Screening of the Low Risk Foot 5 3.4 Management 5 4.0 At Risk Foot [Moderate Risk (Amber), High Risk (Pink)] 6 4.1 Moderate Risk Foot (Amber) 6 4.1.1 Foot Examination Frequency 6 4.1.2 Examiners 6 4.1.3 Examination 6 4.1.4 Management 6 4.1.5 Clinical Governance 7 4.2 High Risk Foot (Pink) 7 4.2.1 Foot Examination Frequency 7 4.2.2 Examiners 7 4.2.3 Examination 7 4.2.4 Management 8 4.2.5 Clinical Governance 8 5.0 Active Foot Disease (Red) 9 5.1 Referral 9 5.2 Foot Examination Frequency 9 5.3 Examiners 9 5.4 Examination 9 5.5 Management 9 5.6 Clinical Governance 10 Appendix 1 Integrated Model of Management/Care Pathway for People with Diabetic Foot Problems 12 Appendix 2 Diabetes Foot Screening Instructions 13 Appendix 3 Diabetes Foot Screening Tool 15 Appendix 4 Referral to Foot Protection Service 16 Appendix 5 Diabetes Peripheral Vascular Assessment Form 17 Appendix 6 Diabetes Foot Ulcer Assessment Continue reading >>

Comprehensive Foot Examination And Risk Assessment

Comprehensive Foot Examination And Risk Assessment

A report of the Task Force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists It is now 10 years since the last technical review on preventative foot care was published (1), which was followed by an American Diabetes Association (ADA) position statement on preventive foot care in diabetes (2). Many studies have been published proposing a range of tests that might usefully identify patients at risk of foot ulceration, creating confusion among practitioners as to which screening tests should be adopted in clinical practice. A task force was therefore assembled by the ADA to address and concisely summarize recent literature in this area and then recommend what should be included in the comprehensive foot exam for adult patients with diabetes. The committee was cochaired by the immediate past and current chairs of the ADA Foot Care Interest Group (A.J.M.B. and D.G.A.), with other panel members representing primary care, orthopedic and vascular surgery, physical therapy, podiatric medicine and surgery, and the American Association of Clinical Endocrinologists. The lifetime risk of a person with diabetes developing a foot ulcer may be as high as 25%, whereas the annual incidence of foot ulcers is ∼2% (3–7). Up to 50% of older patients with type 2 diabetes have one or more risk factors for foot ulceration (3,6). A number of component causes, most importantly peripheral neuropathy, interact to complete the causal pathway to foot ulceration (1,3–5). A list of the principal contributory factors that might result in foot ulcer development is provided in Table 1. The most common triad of causes that interact and ultimately result in ulceration has been identified as neuropathy, deform Continue reading >>

The Diabetic Foot

The Diabetic Foot

CONTENT Definition Epidemiology Social & Economic factors Pathophysiology of foot ulceration Diabetic Neuropathy Peripheral Vascular Disease & Diabetes Biomechanics of Foot Wear The Diabetic Foot Ulcer Outcome & Management Neuro-osteoarthropathy Amputation in Diabetic Patient Prevention of Foot Problem Diabetic Foot Definition: Infection, ulceration or destruction of deep tissues associated with neurological abnormalities & various degrees of peripheral vascular diseases in the lower limb (based on WHO definition) Epidemiology 40% - 60% of all non traumatic lower limb amputation 85% of diabetic related foot amputation are preceded by foot ulcer 4 out of 5 ulcer in diabetics are precipitated by trauma 4% -10% is the prevalence of foot ulcer in diabetics Epidemiology In Sudan: Prevalence of DM ? 6 – 12 % DSF inpatient KTH : 30% - 40% risk of major amputation 8% - 20% mortality Social & Economic Factors Diabetic foot complications are expensive : (cost of healing 7000-10000 USD) (healing with amp. 43000-63000USD) In Khartoum : (4 weeks dressing cost 110000SD) Intervention of foot care is cost effective in most societies Scarce information regarding long term prognosis Diabetic Neuropathy Sensorimotor & peripheral sympathatic neuropathy are major risk factors for ulcer History & careful foot examination are mandatory to diagnose neuropathy Up to 50%of type2 diabetic patient have significant neuropathy & at risk of foot ulcer Periphral vascular disease& diabetic PVD PVD is the most important factors related to outcome of diabetic foot ulcer PVD is diagnosed by simple clinical examination non invasive vascular test determines probability of healing Symptoms of ischemia may be masked by neuropathy Microangiopathy shouldn't be accepted as primary cause of ulcer Conservat Continue reading >>

Diabetes, Foot Ulcer

Diabetes, Foot Ulcer

You have successfully created a MyAccess Profile for Diabetes, Foot Ulcer. In: Simel DL, Rennie D. Simel D.L., Rennie D Eds. David L. Simel, and Drummond Rennie.eds. The Rational Clinical Examination: Evidence-Based Clinical Diagnosis New York, NY: McGraw-Hill; 2009. Accessed April 11, 2018. . "Diabetes, Foot Ulcer." The Rational Clinical Examination: Evidence-Based Clinical Diagnosis Simel DL, Rennie D. Simel D.L., Rennie D Eds. David L. Simel, and Drummond Rennie. New York, NY: McGraw-Hill, 2009, Foot problems in patients with diabetes are common, but infections with osteomyelitis are extremely serious as they lead to an increase probability of amputation or death from complications. Among patients with diabetes with foot ulcers, about 15% have osteomyelitis. 1 Diabetic Population in Whom Osteomyelitis Should Be Considered Patients with diabetes may have a peripheral neuropathy that decreases their ability to perceive pain, so all patients with diabetes are at risk for foot ulcers. Thus, frequent self-examination by patients and observation of their feet by their physicians is important. All patients with foot ulcers should be evaluated for osteomyelitis. Assessing the Likelihood of Osteomyelitis The assessment should focus on the physical examination findings and the erythrocyte sedimentation rate ( Table 57-1 ). Ulcer area > 2cm2 or the ability to probe to bone are the findings most suggestive of osteomyelitis. An erythrocyte sedimentation rate 70mm/h is similarly useful for identifying patients more likely to have osteomyelitis. These individual findings work as well, or better, than the clinical gestalt (LR+ 5.5, 95% CI 1.8-17) and an abnormal radiograph (LR+ 2.3, 95% CI 1.6-3.3). Inflammatory signs and swab culture are not useful as the likelihood ratio (LR) con Continue reading >>

How To Do A 3-minute Diabetic Foot Exam

How To Do A 3-minute Diabetic Foot Exam

› Screen for lower extremity complications at every visit for all patients with a suspected or confirmed diagnosis of diabetes. A › Consider implementing a risk-based referral system to connect primary screening with a specialist's care. A Strength of recommendation (SOR) A Good-quality patient-oriented evidence B Inconsistent or limited-quality patient-oriented evidence C Consensus, usual practice, opinion, disease-oriented evidence, case series Foot ulcers and other lower-limb complications secondary to diabetes are common, complex, costly, and associated with increased morbidity and mortality.1-6 Unfortunately, patients often have difficulty recognizing the heightened risk status that accompanies the diagnosis of diabetes, particularly the substantial risk for lower limb complications.7 In addition, loss of protective sensation (LOPS) can render patients unable to recognize damage to their lower extremities, thus creating a cycle of tissue damage and other foot complications. Strong evidence suggests that consistent provision of foot-care services and preventive care can reduce amputations among patients with diabetes.7-9 However, routine foot examination and rapid risk stratification is often difficult to incorporate into busy primary care settings. Data suggest that the diabetic foot is adequately evaluated only 12% to 20% of the time.10 In response to the need for more consistent foot exams, an American Diabetes Association (ADA) task force lead by 2 of the authors of this article (AB and DA) created the Comprehensive Foot Examination and Risk Assessment.5 This set the standard for the detailed investigation of lower limb pathology by a specialist, but was not well suited for other practice settings, including primary care. One reason is that it would be diffi Continue reading >>

Diabetic Foot Examination – Osce Guide

Diabetic Foot Examination – Osce Guide

Diabetic foot examination frequently appears in OSCEs. You’ll be expected to pick up the relevant clinical signs using your examination skills. This guide provides a clear step by step approach to examining diabetic feet, with an included video demonstration. Check out the diabetic foot examination mark scheme here. Introduction Wash hands Introduce yourself Confirm patient details – name / DOB Explain the examination Gain consent Position patient on an examination couch at 45° Expose patient’s lower legs and feet Gather equipment Monofilament Tuning fork (128 Hz) Tendon hammer Inspection Inspect legs and feet thoroughly (make sure to inspect the posterior aspects of the legs and between the toes) Colour – pallor / cyanosis /erythema (e.g.ischaemia / cellulitis) Skin: Dry / shiny / hair loss – peripheral vascular disease (PVD) Eczema / haemosiderin staining – venous disease Ulcers – inspect limbs thoroughly (including posterior aspects and between toes) Venous ulcers – moderate to no pain – larger /shallow – associated with venous insufficiency / varicose veins Arterial ulcers – very painful – deep punched out appearance – associated with diabetes mellitus / peripheral vascular disease Swelling: Oedema – – e.g. venous insufficiency / heart failure Deep vein thrombosis – tender on palpation Calluses – may indicate incorrectly fitting shoes Venous filling – guttering of veins / reduced visibility suggests PVD Deformity caused by neuropathy (e.g. Charcot arthropathy) Palpation Temperature – cool (e.g. PVD) / hot (e.g. cellulitis) Capillary refill time – normal: < 2 seconds – prolongation suggests PVD Pulses: Dorsalis pedis artery – lateral to extensor hallucis longus tendon Posterior tibial artery – posterior and inferior to m Continue reading >>

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