Comprehensive Head-to-Toe Examination for Patients with Diabetes

General Assessment

The American College of Cardiology recommends beginning with vital signs, including blood pressure measurements in both arms to identify potential subclavian artery stenosis (difference >15-20 mmHg between arms) 2
A general assessment should include evaluating overall body habitus, looking for evidence of wasting, obesity, or lipodystrophy, as well as assessing general appearance, level of consciousness, and apparent distress 3

The American College of Cardiology suggests auscultating carotid arteries for bruits 2
Palpate lymph nodes in the neck for enlargement or tenderness, and inspect the head for deformities, lesions, and symmetry 3

Auscultate lungs for breath sounds, crackles, wheezes, or rubs, and auscultate heart for rate, rhythm, and presence of murmurs, gallops, or rubs 3
Inspect chest wall for symmetry of movement and use of accessory muscles, and palpate for tactile fremitus and chest wall tenderness 3

Auscultate for bowel sounds and bruits, and palpate for tenderness, masses, organomegaly, or pulsatile masses 3
Inspect for distension, visible peristalsis, or pulsations 3

Assess range of motion of major joints, and evaluate for joint deformities, swelling, or tenderness 3
Test muscle strength in all extremities, and assess for foot deformities such as bunions, hammertoes, and prominent metatarsals that increase plantar foot pressures and risk for ulcerations 1

Evaluate mental status and cognitive function, and test sensory function using the 10-g monofilament test, pinprick or temperature perception, and vibration testing with a 128-Hz tuning fork 1, 4
Assess deep tendon reflexes, including ankle reflexes, and evaluate coordination and gait 1, 3, 4

Palpate peripheral pulses (femoral, popliteal, dorsalis pedis, and posterior tibial), and assess for capillary refill time, rubor on dependency, pallor on elevation, and venous filling time 1, 2
Note any signs of peripheral arterial disease, including decreased walking speed, leg fatigue, or claudication 5

Inspect skin for integrity, color, moisture, temperature, and turgor, and identify any lesions, ulcerations, calluses, or wounds 1
Pay particular attention to feet and pressure points in patients at risk for skin breakdown 1

Perform comprehensive foot examination at least annually, including skin integrity assessment, foot deformity evaluation, neurological assessment with the 10-g monofilament and at least one other test, and vascular assessment including pulses 1, 6
Obtain history of ulceration, amputation, Charcot foot, vascular surgery, smoking, retinopathy, and renal disease, and inspect feet at every visit for patients with sensory loss or prior ulceration/amputation 1, 6