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) [xeroderma (dry skin)/hypo- and anhidrosis (decreased ability to perspire to inability to perspire); disorders of the skin, e.g., chronic wound]
- Musculature [muscular atrophies]
- Gait pattern [e.g., gait instability]
- Acquisition of muscle and joint function
- Foot [foot deformities, as evidence of diabetic neuroosteoarthropathy]
- 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).
- Auscultation (listening) of the heart [resting tachycardia: > 100 beats/min].
- 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!).
- Reflexes (Achilles reflex) [reflex attenuation].
- Motor function [tone reduced, muscle atrophies, paresis (paralysis)]
- Sensitivity measurement:
- Vibration sensation with the 128 Hz tuning fork according to Rysel-Seiffer [early sign of diabetic polyneuropathy: decreased vibration sensation in tuning fork test].
- Pressure and touch sensation with 10 g monofilament.
- Cold-warm discrimination [heat and cold allodynia].
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.
