Originally Posted by Mark_M
With continuing diabetic foot consultations we always:
palpate pedal pulses
check nerves with a monofilament
perform general treatment
I have accepted this as routine. But why do we need to check pulses and nerves every consultation? Does it change your treatment plan? Would you inform the GP if there is a change?
I can see the benefit on an initial consultation and annual consultation.
If one day your unable to palpate Dorsalis Pedis on a winters morning, what would you do?
I see no added benefit in doing a neurovascular assessment at every consultation (assuming they are presenting for episodic skin and nail care).
After caring for ?1000's of diabetic feet, I am yet to see anything more than mild to moderate variations in the nature and severity of degenerative neuropathy or PAD from year to year. However once established, the sequelae of these issues can naturally occur rapidly and without warning.
Hence, where there is no established diagnosis is in place for DPN or PAD, I feel little is to be gained from anthything other than annual screening.
BTW - if you can palpate a pulse, and note reasonable capillary fill times in the absence of claudiction and other risk factors - I feel there is little indication for Doppler assessment - providing you do not suspect cardiac arrythmia or other. I think the trend towards Doppler/ABI at every annual review is overkill (? exploitation of the MBS in some situations) if there is no clinical suggestion of PAD.
Just my observations,