A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing).
- Skin and mucous membranes (skin temperature, skin tugor and perspiration).
- Gait
- Acquisition of muscle and joint function
- Foot [rhagades?, blistering?, subcutaneous hemorrhages?; hyperkeratosis (keratinization)?, signs of bacterial infection and/or mycosis (fungal disease)?, foot deformities, as evidence of diabetic neuroosteoarthropathy, foot ulcer (foot ulcers)?]
- Shoes and insoles (tactile control).
- Palpation of the peripheral pulses (palpation of the foot pulses of the tibial artery and the dorsalis pedis artery, on both sides).
- Tuning fork test for diagnosis and progression of diseases associated with decreased vibration sensation (pallhypesthesia) and decreased depth sensitivity [diabetic polyneuropathy?].
- Auscultation (listening) of the heart.
- Auscultation of the lungs
- Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?)
- Inspection (viewing).
- Neurological examination (examination always bilateral!).
- Muscle reflexes (Achilles tendon reflex and patellar tendon reflex).
- Motor function
- Sensitivity measurement:
- Touch sensation (e.g., with cotton swab).
- Pressure and touch sensation with 10 g monofilament.
- Cold-hot discrimination
- Pain identification [findings in sensorimotor diabetic polyneuropathy: bilateral: limb-segment determination (e.g., sock-shaped)]
- Temperature sensation (e.g., cold metal/vocal fork).
- Vibration sensation with the 128 Hz tuning fork according to Rysel-Seiffer [early sign of diabetic polyneuropathy: decreased vibration sensation in the tuning fork test].
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.
