Diabetic Foot Examination | Nurse Practitioners
Hey guys! Welcome back to the Kim E. The Diabetes NP blog! Today let’s talk about the diabetic foot exam. As NURSE PRACTITIONERS, we need to make it a habit to check our patients' feet when they come into the office. Not only do we need to access their feet but we also need to educate our patients over proper diabetic foot care so they will be empowered at home to care for their feet. Some may think that this is excessive but, this is a simple way to prevent any complications and decrease the advancement of any diabetic complications that already exist.
Now when it comes to diabetes complications, I covered the macrovascular and microvascular complications seen in diabetics earlier in the year but the primary complications that can be prevented with regularly foot exams are neuropathy, peripheral artery disease, and even amputations. In this particular post, I would like to key in on the responsibility of the nurse practitioner. Below is an overview of what to include in your clinical foot exam:
Inspection of the feet
This should be considered with every diabetic especially if there is some sensory loss. If they are already complaining of numbness or loss of feeling, you should definitely be looking at those feet with every visit. This is a great time to access the need for diabetic shoes and socks. Once their socks and shoes are off, take some time to look at the nails for suppleness, assessing for calluses, corns, or other deformities. Is there any redness, cuts, or nicks of the skin? How’s the color of the extremity and is hair growing properly and evenly? Being that you can inspect multiple things at one time, this is not something that would take much time.
Palpation of the feet
When touching the feet, note the temperature of the extremity. Is it cool or warm? Unusually warm areas could alert you to inflammation or infection. Also, feel for the pulses and grade them appropriately. Assessing for capillary refill or swelling to any degree can be noted during this time.
Screening for Peripheral Artery Disease (PAD)
There are two primary tests used to screen and diagnose PAD: Quantaflo & Ankle-Brachial Index. Other items to perform: a monofilament on the bottom and dorsal side of the foot to test for light touch sensation, a tuning fork to the great toe to test for vibratory sensation, and ankle reflexes with a reflex hammer and grade accordingly. I will discuss these items in more detail in a later post but for now, I’ll stop here!
I hope that this was helpful and that you learned something that you didn’t know. I also created a video over this very topic, so take a watch below and please consider subscribing to my YouTube channel, Kim E. The Diabetes NP. and following me over on Instagram, @thediabetesnp.
