| COMPONENT |
ASSOCIATED PATHOPHYSIOLOGICAL INVOLVEMENT |
ASSESSMENT CONSIDERATIONS |
CLINICAL INDICATIONS |
| Sensory |
- Myelin sheath is disrupted by hyperglycemia
- Disruption leads to the segmental demyelinization process accompanied by a slowing of motor nerve conduction and an impairment of sensory perception
|
- Pressure perception testing using a 10-gr* (5.07 Semmes-Weinstein) monofilament, is recommended
- Vibration perception (using a tuning fork)
- Tactile sensation (using a cotton ball)
|
- Loss of protective sensation
- Sensory ataxia
- Falls (15-fold increase compared to those without diabetes)
- Callus
|
| Autonomic |
Sympathetic Denervation
- Loss of vasomotor control
- Peripheral blood flow
- Arteriovenous shunting
- Bone blood flow hyperemia
- Glycosylation of collagen
|
Inspect for:
- Dry scaly skin caused by lack of hydration
- Inspect between the toes especially between the fourth and fifth toes for fissures
- Maceration
- Loss of hair growth and thickened toenails
|
- Anhydrosis
- Callus
- Fissure cracks
- Onychomycosis (fungal nails)
- Peripheral edema
- Waxy skin (sign of altered joint mobility)
|
| Motor |
- Non-enzymatic glycosylation
- Atrophy of intrinsic muscles of the foot (toe plantar flexors)
- Subluxation of metatarsophalang at joints
|
Inspect for:
- Gait assessment
- Range of motion
- Muscle testing
- Absent deep tendon reflexes
|
- Callus
- Claw toes
- Hammer toes
- Charcot arthropathy
- Muscle weakness
- Ankle equines
- Pes cavus
- Pes planus
- Contracture of Achilles Tendon
|
