What to Expect from a Comprehensive Diabetic Foot Examination

Recently you have been diagnosed with diabetes and your primary care doctor has referred you to a podiatrist for a diabetic foot examination.  Now as you sit in the examination chair you begin to wonder about what this examination entails and why a new specialist was just added to the list of doctors.

A podiatrist is a physician especially trained in diseases that affect the foot. A comprehensive diabetic foot examination is a painless series of non-invasive office tests that a podiatrist conducts to evaluate diabetes’ effect on the feet.  The goal of a yearly foot examination is to evaluate the effect of diabetes on our feet by looking at the blood flow, the skin, sensation, muscle and overall foot structure. A comprehensive diabetic foot evaluation and appropriate foot care can reduce risk of an amputation from 45% to 85%[1]. The doctors at Allentown Family Foot Care are focused on keeping you on your feet.

A checklist of what is to be expected from a painless comprehensive diabetic foot exam as conducted by a podiatric physician is included below.

What your doctor will evaluate:

Blood-flow: (Vascular Examination)

• Pulses
• Capillary refill
• Checks for varicose veins

Skin (Dermatological Examination)

• Skin
• Nails

Nerves (Neurological Examination)

• Vibratory (Tuning fork)
• Protective (Weinstein monofilament)

Muscle strength testing

Foot structure (Orthopedic Examination)

With checklist in hand let us review why each component of the comprehensive diabetic foot exam is important.

1.      Blood-flow: (Vascular Examination): Blood flow is important because it is indication of our ability to heal.  Poor blood flow leads to slower healing and a greater risk of injury.  Arteries are large vessels by which oxygen rich blood travels away from the heart. There are two major arteries by which blood is supplied to the foot. The doctor can feel one on the top of the foot, and the second on the inside near the ankle.  Arteries become smaller and smaller to form capillaries, these small vessels ensure that oxygen rich blood reaches our skin and our nerves.  The doctor will press on the tip of your toe to gauge capillary refill time.  Arteries carry oxygen-rich, whereas, veins carry oxygen poor blood back to the heart. When veins become over-worked they fill with blood and become swollen a condition termed varicose veins.  The presence of varicose veins suggests a need for compression stockings to help veins return the blood back to your heart.  Additionally wearing compression stockings helps to prevent tired legs and skin breakdown. The doctor at AFFC and you will review the vascular health of foot.

2.      Skin: (Dermatological Examination):  Your skin is your body’s first defense against the outside world.  A breakdown in the skin can become a potential source of infection and pain. Red marks and build-up of skin (corns and callus) are indications of increased pressure and can result in painful walking and eventually lead to open wounds. Trimming of the corns and callus by an AFFC doctor can help to decrease pain and deter a wound from forming. Keeping the toenails at a healthy length reduces pressure and helps to decrease the risk of a toe amputation.  The doctor at AFFC will review your skin’s health and help you in keeping your skin soft and supple.

3.      Nerves: [Neurological Examination]: The sensations we experience improve our life and keep us safe. If we cannot feel not only do we not experience life to the fullest instead we also dramatically increase our risk of injury. Too high of blood sugar levels quickly deaden the nerves accelerating diabetic neuropathy.  A tuning fork is used to evaluate vibratory sensation. A decrease in vibratory sensation is the earliest indication of neuropathic changes associated with diabetes. Similar to a toothbrush bristle in structure, a Weinstein monofilament is a flexible bristle that gauges the body’s ability to sense  “stepping on something”.  Failure to feel the Weinstein monofilament indicates that efforts must be made to protect your feet. Your AFFC doctor and you will discuss strategies to protect your feet.

4.      Muscle strength: Diabetes also alters your muscle strength, causing weakness in the legs and in the feet. The doctor will grade your muscle strength and can advise how to help strengthen muscle via exercises and use of orthotic devices.

5.      Foot structure: (Orthopedic Examination): Foot shape and function can influence how susceptible to injury you are.  Bony prominences, such as bunions, can rub in too tight of shoes leading to increased pressure and ulcers.  Shoes can irritate a toe that sticks up, eventually causing the skin to breaks down and a wound to form. The doctors at AFFC can provide shoe recommendations to best suited to fit your unique foot structure and needs. 

The comprehensive foot examination is the first line of defense against amputation of your toes, your foot and even your legs. Research indicates that diabetes accounts for 60% of nontraumatic amputation of the lower-limb within the United States[1]. Although the CDC recently reported a 65% decline in the lower-limb amputation rates in persons over 40 years of age (3.9/1,000 adult diabetics in 2008 versus 11.2/1,000 adult diabetics in 1996)[2], it is important to understand that diabetes still results in amputation rate eight times higher versus adults without the disease[2]. Diabetics will undergo an amputation at some point without proper care. A grim reality that can be avoided by a comprehensive diabetic foot examination and appropriate preventive foot care which have been demonstrated to reduce risk of amputation from 45% to 85%1. Both the staff and doctors at Allentown Family Foot care value the importance of the comprehensive diabetic foot exam, and are especially trained to ensure that you keep your best foot forward. 

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