Peripheral vascular disease

Peripheral vascular disease is an important risk factor for diabetic foot disease which still leads to the loss of 5,000 lower limbs every year in the UK. It should be detected early by examining pedal pulses at the annual review and managed actively with lipid modification, smoking cessation, antiplatelet agents and surgical referral for revascularisation.

General examination

A thorough general and systems examination is an essential part of the assessment of any patient with a diabetes complication.

Cardiovascular

Assess for signs of cardiac failure, which may be due to previous myocardial infarction.

Is the patient hypertensive?

Arterial examination

A thorough assessment of the arterial tree can be performed clinically. This should include palpating the femoral, popliteal, posterior tibial and dorsalis pedis pulses.

In addition, the abdominal aorta should be palpated to assess for aneurysm, the femoral and carotid arteries should be auscultated for bruits and the abdomen should be auscultated for renal bruits.

Feet

In addition to palpating the pedal pulses, the feet should be inspected for ulceration and gangrene, their colour should be noted, they should be palpated for temperature, the capillary refill time noted and trophic changes such as hairlessness of the lower leg should be recorded.

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