diagnosis of diabetic neuropathic ulcer

Last reviewed 07/2021

diagnosis

Medical history and physical examination will establish presence of diabetic neuropathy

  • patients may complain of symptoms of  peripheral neuropathy e.g. - burning sensation; pins and needles; shooting, sharp, or stabbing pains; and muscle cramps, which are distributed symmetrically in both limbs (“stocking and glove distribution”), 
  • Neuropathy Symptom Score (NSS) can be used to screen for peripheral neuropathy in diabetes 
  • physical examination of the foot will inspect
    • perception of superficial pain (pinprick)
    • temperature sensation - using a two-metal rod
    • light sensation - using the edge of a cotton-wool twist
    • pressure - using the Semmes–Weinstein 5.07 monofilament
    • vibration perception - using a tuning fork and/or a biothesiometer

  • tissue surrounding the ulcer is generally warm and well perfused, sweating is diminished, and the skin may be dry and prone to fissuring
    • peripheral pulses are often palpable
    • there is generalised sensory impairment
    • often there is a history of minor trauma that precedes the development of the ulcer (1,2,3)

Neuropathy Disability Score (NDS) can be used to establish neuropathic deficits in the feet (3).

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