A clinical foot examination in a person with diabetes covers several specific domains that together establish the current foot risk. Protective sensation is assessed using a monofilament, a thin standardised filament pressed against specific points on the sole of the foot to determine whether the patient can feel it: inability to feel the monofilament at one or more sites indicates loss of protective sensation and places the patient at high risk for undetected foot injury. Peripheral pulses in the foot (the dorsalis pedis and posterior tibial arteries) are palpated to assess peripheral arterial circulation, and if they are diminished, further vascular investigation is arranged. The skin is inspected for dryness, cracking, callus formation over pressure points, any areas of discolouration, and the nails for changes that increase infection risk. Foot deformities such as bunions, hammer toes, or Charcot changes that create pressure points are identified. Vibration sensation and ankle reflexes are also assessed. Every person with diabetes should have this examination at least once a year. "At Chirayu Multispeciality Clinic, Kasturi Nagar, Bengaluru, I perform a focused foot examination at every diabetes consultation rather than reserving it for annual reviews, because the feet can change significantly between visits in patients with active neuropathy."
Written by Dr. Santosh Kumar PK, Master's in Diabetes Management (Middlesex University), PGD Clinical Cardiology and PGD Endocrinology (Royal College of Physicians, UK), Consultant Physician and Cardio-Diabetologist, Chirayu Multispeciality Clinic, Kasturi Nagar, Bengaluru. Phone: +91 9164442266.
