Diabetic Foot Examination - Clinical Skills - Dr Gill

[Music] hello my name is Dr Gil I've been asked to a diabetic foot assessment on yourself before we go any further could you please confirm your name and date of birth at Tois Ali 4th of January 2000 super so in terms of doing this examination it's going to involve you walking up and down so we have a look at your gate I'm going to be pressing around your feet and then also U applying a monofilament and a tuning for to your feet to make sure that you have good sensation so before we go on are you happy to proceed with this yep fantastic so um I'm just going to have a a quick look at your gate so if you get up please walk at least Five Paces turn and come back super so I can't see any problems with uh your gate that's ground so if you lie back on the bed and going have a good look at your feet so having a look high um so you've got normal hair on the legs I can't see any evidence of hair loss on the top there's no obvious scars nor can I see any underneath um there's no uh evidence of deformity to either foot and I can't see any evidence that suggests you might have have previous fractures there's obviously no an amputations looking around the legs there's no signs of um ulcers at all that being Venus or arterial on the bottom of the feet there's no evidence of calluses and I can't see any other problems with the soles of the feet and there's no um bruising injuries anything like that to the toes so that looks fantastic I'm going to start off just by putting my hands on your legs so there's the dorsalis pedis which is fantastic and then coming up behind doing the posterior tibial so youve got no issues there that's fine so just having a look over so just having a look over the legs I can see we've got normal hair we've not got any loss of hair I can't see any evidence of amputations there's no uh ulcers both Venus and arterial I can't see any evidence of previous fractures there's no discoloration to either um leg or foot looking at the base of the foot there's no evidence of calluses uh nor can I see any contusions uh to the uh toes um they seem to have normal uh coloration there's no scars at all I'm not going to see any evidence of sinosis so blowing to the toes or any gang grein so everything looks normal here and there's no evidence of any deformities such as we might see with Shar out to foot as we might see with a Shar out the foot the temperature so your temperature is normal on your feet all the way down now we're going to have a look at the capillar refill so you're just going to squeeze on your toe and on the opposite side so we've got completely normal capillar refill on both sides so we've got no issues there um I'm going to have a look at the uh the pulses so pressing over the dorsalis speedis so we got no problems there then moving around to the posterior tibial again we've got good pulses coming through uh uh evenly on both sides so let's have a look and see um how we are with sensation so this is a monofilament so it's a little piece of plastic that bends when we put Force through it it's not going to do any harm I'm just going to touch your chest if you don't mind so you can feel me touching you there great so I'm going to do the same on uh your feet when I do so I need you to keep your eyes closed and please say yes when we feel we touch you okay so if you close your eyes please yes fantastic so there's no problems with the uh sensation there now I'm going to have a look at vibration so this is a tuning fork if I strike it it'll vibrate and if put on your chest you can feel the vibration mhm okay tell when it stops stops great so we're going to do the same thing on uh your toes so I'm going to strike the tuning fork I'll apply the vibration you should feel it I'm going to get you to close your eyes and I need you to tell me when the vibration stops okay so if you close your eyes for me so you can feel the vibration mhm okay tell when the vibration stops stop super we'll do the same on the opposite side you can feel the vibration okay please close your eyes tell when it stops stop fantastic plastic so we got normal vibration sense so I've got no concerns there about that now I'm going to have a look at um what's called Pro reception your ability to determine where your body is so I'm just going to hold on to your big toe okay and I'm going to move it up or down okay so waggling forwards that will be up and this will be down okay so I want you to close your eyes and if you tell me which way your foot is pointing okay so if you close your eyes now and tell me which way your toe is pointing super we're going to do the same again on the side so again if you open your eyes please so you can see the toes up M and then can you feel the toes down okay so if you close your eyes up down up down down up fantastic so you've got normal Pro perception there so that is very good okay so um everything seems to be normal so far now I'm just going to have a look at your reflexes so I'm just going to roll your leg in and out and just going to squeeze the calf so we got good movement there I'm just going to strike the ankle okay so we got good reflex there and relax for me we'll do the same again over this side so leg up good we got movement at the ankle relax for me good so we've got a reasonable Reflex on both sides um I'd like to double check that by just getting you to uh kneel on one of the uh chest for me so if you just come over here so if you could kneel with one foot onto the chair for me brilliant I'm just going to squeeze your calf and we've got good movement at the uh ankle so I'm just going to put some Force there just try and relax for me loose and floppy excellent so we got good reflexes there and if you could swap legs for me okay I'm going do the same again I'm just squeeze the calf so you can see the foot moving to put a little bit of force there and relax excellent so we got fantastic reflex there thank you let's head back over here so the final thing I need to do is just have a quick look at the base of your shoes I can't see any abnormal wear patterns and on the opposite side I can't see any obvious deformities looking over the shoes themselves I can't see any obvious strains anywhere on the outside that might suggest that the shoes weren't fitting you um and we've seen you've got good sensation so it's highly unlikely with end up in that situation so um that completes our Examination for the time being uh we' also like to uh check fundoscopy so have a look in your eyes I'd also like to do a peripheral vascular disease assessment and also check your blood sugars uh uh fingerprint blood sugar whilst you're here do you have any other questions for myself no super well I'll let you put your get dressed and thank you very much thank [Music] you [Music]