Neurovascular Examination of the Feet

Components of the Neurovascular Examination

A comprehensive neurovascular examination of the feet should include inspection of the skin, assessment of foot deformities, neurological assessment, and vascular assessment, according to the American Diabetes Association 1, 2
Prior history of ulceration, amputation, or Charcot foot should be obtained during history taking, as recommended by the American Diabetes Association 1, 3
Symptoms of neuropathy, such as pain, burning, or numbness, and symptoms of vascular disease, such as leg fatigue, claudication, or rest pain, should be assessed during history taking, as recommended by the American Diabetes Association 1, 3, 4
Skin integrity should be examined, looking for ulcerations, pre-ulcerative lesions, calluses, areas of hyperemia, dryness, scaling, or fungal infections, as recommended by the American Diabetes Association 1, 4, 5
Neurological assessment should include 10-g monofilament testing and at least one additional test, such as pinprick sensation, temperature perception, or vibration testing, as recommended by the American Diabetes Association 1, 2, 6
Vascular assessment should include palpation of pedal pulses, such as the dorsalis pedis artery and posterior tibial artery, and additional assessments, such as capillary refill time, rubor on dependency, pallor on elevation, and venous filling time, as recommended by the American Diabetes Association 1, 2, 3

Patients can be stratified into risk categories based on examination findings, with very low risk patients having no loss of protective sensation (LOPS) and no peripheral arterial disease (PAD), and high risk patients having LOPS or PAD with a history of foot ulcer, amputation, or end-stage renal disease, as recommended by the American Diabetes Association 7

Patients with abnormal findings should receive education on daily foot inspection, proper nail and skin care, appropriate footwear selection, and the importance of regular follow-up based on risk category, as recommended by the American Diabetes Association 1, 8, 7, 9

The American Diabetes Association recommends performing 10-g monofilament testing at plantar sites, as well as assessing dorsalis pedis and posterior tibial pulses, to evaluate for loss of protective sensation and vascular compromise in patients with flat feet 10
The assessment of foot deformities, including bunions, hammertoes, and prominent metatarsal heads, is crucial in identifying structural deformities that increase plantar pressures and ulceration risk, as recommended by the American Diabetes Association 10
The American Diabetes Association suggests evaluating capillary refill time, rubor on dependency, pallor on elevation, and venous filling time if vascular compromise is suspected in patients with flat feet 10