Diagnosis of diabetic neuropathic ulcer

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).

Reference:

• (1) International Best Practice Guidelines: Wound Management in Diabetic Foot Ulcers. Wounds International, 2013
• (2) Edmonds ME, Foster AVM. Diabetic foot ulcers. BMJ : British Medical Journal. 2006;332(7538):407-410
• (3) Alexiadou K, Doupis J. Management of Diabetic Foot Ulcers. Diabetes Therapy. 2012;3(1):4