2 IntroductionThis presentation walks you through the process of conducting a diabetic foot assessment and examining the results.Part 1 – Vascular & Doppler AssessmentsPart 2 – SCRT & ABPI Measurements and ResultsPart 3 – Sensory Neuropathy Tests and Other Neuropathy Tests
4 Vascular AssessmentPalpate Dorsalis Pedis and the Posterior Tibial pulse.Apply ultrasound coupling gel to the areas where the pulses were palpable.Place the Doppler probe firmly onto the skin.Hold the probe at +/- 45°.Record the loudest and clearest sound.
5 Left foot, the Dorsalis Pedis artery. Doppler AssessmentLeft foot, the Dorsalis Pedis artery.Dorsalis Pedis artery
9 Subcapillary Plexus Refill Time [SCRT] Apply pressure on the apex of the Hallux.Hold firmly for a couple of seconds.Release the pressure.Note the time in which the colour of the toe returns to normal.Under 3 seconds – normal, over 4 seconds the cutaneous circulation is compromised.
10 Ankle-Brachial Pressure Index [ABPI] Measure the brachial pressure using a correctly size cuff.
11 Ankle-Brachial Pressure Index [ABPI] Measure the ankle pressure in the Posterior Tibial [TP] and the Dorsalis Pedis arteries [DP].
12 Ankle-Brachial Pressure Index [ABPI] Use the highest reading (i.e. TP or DP) and the highest brachial reading.Divide the ankle over the brachial pressure to obtain ABPI number or use ABPI chart.
13 ABPI - Results >1.3 - Possible calcification of arteries. – Normal.0.5 – 1 - Upper limit – minor disease.- Midrange-significant, symptomatic disease [sign-intermittent claudication].- Lower limit severe ischaemia [signs- intermittent claudication and rest pain].- < 0.5 – Critical limb ischaemia.
14 PART 3: Sensory Neuropathy Tests and Other Neuropathy Tests
15 Neurological Assessment Sensory neuropathy – signs and symptoms [s/s]: burning, tingling, painful or numb feet.Motor neuropathy s/s: loss of proprioception, history of falls, pes cavus [high arched foot], clawed toes etc.Autonomic neuropathy s/s: reduced sweating, dry feet, bounding pedal pulses, impotence, incontinence etc.
16 Sensory Neuropathy Tests 10 g Semmes-Weinstein monofilament test: ask patient [pt] to shut their eyes, apply pressure until the filament buckles, release the pressure, ask patient if/where they felt it?Use 5-10 different sites on both feet.
17 Vibration test using a neurothesiometer Vibration test using a neurothesiometer. Use bony prominences of the foot (i.e. apex of the Hallux, 1st MPTJ, medial malleolus). It gives a quantative data for each test which can be recorded to observe the progression of neuropathy. Readings over 25 V indicate neuropathy.
18 Vibration test using a 128MHz tuning fork: ask pt to shut their eyes, vibrate the fork and ask the patient what they feel – they should feel vibration/‘buzzing’ in the tested area, not above it. Ask them when the sensation stops and record the results.
19 Neuropathy - Other Tests Sharp/blunt test - use a neurotip.Temperature test – use a thermatip or one cold and one warm test tube.Light touch – use a tissue or cotton wool.Proprioception – dorsiflexion/plantarflexion of the Hallux.