Examination: Alcoholic Foot

Casebank Combined
1

Who are you?
You are the F2 in the GP surgery.

Who is the patient?
Mr. Andrew Jones, 65 year old, presented with a concern.

What you must do:
Take focused history, perform relevant examination and address the patient’s concerns.

Focused History:

  1. Confirm patient’s details
  2. Identify concern: burning sensation in the feet.
  3. Analyse history:
    • O: Gradually
    • D: Weeks to months
    • I: moderate - severe
    • P: persistent
    • A: nil
    • R: nil
    • A: nil
  4. Past medical history, medication history and allergies
  5. Smoking
  6. Analyse alcohol intake: since when? How much? Type of alcohol?

Examination:

  1. Start with thanking the patient for answering your questions
  2. For the patient: Explain why are you examining the patient
  3. For the patient: Explain that the examination won’t be painful but could be
    uncomfortable
  4. For the patient: Explain what you are going to do during the examination
  5. For you: Explain how you want the patient to be positioned
  6. For you: Explain how you want the patient to be exposed
  7. For you: Explain the contraindications of the examination if present
  8. For both of you: Inform the patient that a chaperone will be present
  9. For both of you: Inform the patient that you will maintain their privacy
  10. For both of you: Finally gain consent by asking ‘ Do I have your consent to proceed?

“Thank you Mr. X for answering my questions. Now I would like to record your blood pressure, heart rate, respiratory rate, temperature and oxygen saturation. I will also perform a general physical examination. Now I would like to examine your feet. I will be looking at your feet and assessing the blood flow and sensation in your feet. The examination won’t be painful but might be a bit uncomfortable. For the purpose of the examination, I would like you to be bare below the knee. I will examine you while you are seated on the bed. I will have a member of the medical team with me as a chaperone and I will ensure your privacy. Are you happy for me to proceed?”

Once you gain consent, you can start to examine the patient. Your examination will consist of:

  1. Assessing the gait
  2. Assessing the patient’s shoes
  3. Inspection of the foot
  4. Palpation of the foot
  5. Sensory examination

  1. Assessing the gait
    • Look at the patient’s gait while he is moving from the chair to the couch.
  2. Assessing the patient’s shoes
    • Ask the patient if it’s comfortable
    • Ask the patient if the size is accurate
    • Look inside the shoes for holes
  3. Inspection of the foot
    • Inspect for muscle wasting, redness, deformity, scars, swelling, ulcers.
    • Assess for hair loss.
    • Assess the nails.
    • Look in between the toes for fungal infections.
    • Assess the heels.
  4. Palpation of the foot
    • Compare the temperature of both feet.
    • Palpate the feet for tenderness.
    • Palpate peripheral pulses.
  5. Sensory examination
    • Assess fine sensation using a cotton swab and monofilament.
    • Assess pain, vibration and joint position sensation.