A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height.
- Inspection (viewing) of skin/foot; if diabetic ulcers are present, they should not only be visually assessed but also explored with the aid of probing [involvement of tendons? and bone/osteomyelitis (bone marrow inflammation)?]
- Auscultation (listening) of the heart.
- Palpation (palpation) of the abdomen
- of the further examination of:
- Periphyton pulse status (palpation of the foot pulses of the tibial artery and dorsalis pedis artery, bilaterally).
- Skin temperature, skin tugor (state of tension of the skin) and sweating.
- Foot deformities (indicative of diabetic neuroosteoarthropathy and muscle and joint function).
- Gait pattern
- Shoes and insoles (tactile control)
- Neurological examination including measurement of vibration and pressure perception/vocal fork test (to check for neuropathy) – Examination of feet [burning/sharp pain, especially at rest; altered perception of pain; paresthesias (misperceptions); temperature sensation disturbances].
- Cancer prevention
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.
Differentiation between ischemic, neuropathic and neuropathic-ischemic foot
| Ischemic foot | Neuropathic foot | Neuropathic-ischemic foot | |
| Etiology (causes) | Circulatory disturbance in peripheral arterial occlusive disease (pAVD). | Impaired sensitivity in diabetic neuropathy (polyneuropathy) | PAVK + polyneuropathy |
| Skin temperature | cool foot | warm foot | cool foot |
| Skin color | Pale, possibly cyanotic (purple to bluish discoloration of the skin) | Pale, possibly cyanotic | |
| Painful necrosis (dead tissue) and ulcers (boils) | + | + | + |
| Pressure-loaded areas (sole of foot, heel) | + | + | + |
| Vibration and touch sensation | Normal | ↓ | ↓ |
| Foot pulses | limited or not palpable | well palpable | limited or not palpable |
Risk classification system
| Category | Risk profile | Investigations |
| 0 | No sensory neuropathy (nerve damage resulting in sensory disturbances) | 1 x yearly |
| 1 | Sensory neuropathy | Every 6 months |
| 2 | Sensory neuropathy Signs of peripheral arterial disease (pAVK) Foot deformities. | Every 3 months |
| 3 | Early ulcer (ulcer) | Every 1-3 months |
