Robert Ferry Jr., MD, is a U.S. board-certified Pediatric Endocrinologist. After taking his baccalaureate degree from Yale College, receiving his doctoral degree and residency training in pediatrics at University of Texas Health Science Center at San Antonio (UTHSCSA), he completed fellowship training in pediatric endocrinology at The Children's Hospital of Philadelphia.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Medical evaluation should include a thorough history and physical examination and may also include laboratory tests, x-ray studies of circulation in
the legs, and consultation with specialists.
History and physical examination: First, the doctor will ask the
patient questions about their symptoms and will examine them. This examination should include
the patient's vital signs
(temperature, pulse, blood pressure, and respiratory rate), examination of the sensation in
the feet and legs, an examination of the circulation in the feet and legs, a thorough examination of
any problem areas. For a lower extremity wound or ulcer, this may involve probing the wound with a blunt probe to determine
its depth. Minor surgical debridement of the wound (cleaning or cutting away of tissue) may be necessary to determine the seriousness of the wound.
Laboratory tests: The
doctor may decide to order a complete blood cell count, or CBC, which will assist in determining the presence and severity of infection. A very high or very low
white blood cell count suggests serious infection. The doctor may also check
the patient's blood sugar either by fingerstick or by
a laboratory test. Depending on the severity of the problem, the doctor may also order kidney function tests, blood
chemistry studies (electrolytes), liver enzyme
tests, and heart enzyme tests to assess whether other body systems are working properly in the face of serious infection.
X-rays: The doctor may order x-rays studies of the feet or legs to assess for signs of damage to the bones or arthritis, damage from infection, foreign bodies in the soft tissues.
Gas in the soft tissues, indicates
gangrene - a very serious, potentially life-threatening or limb-threatening infection.
Ultrasound: The doctor may order Doppler ultrasound to see the blood flow through the arteries and veins in
the lower extremities. The test is not painful and involves the technician moving a non-invasive probe over the blood vessels of the lower extremities.
Consultation: The doctor may ask a vascular surgeon, orthopedic surgeon, or both to examine
the patient. These specialists are skilled in dealing with diabetic lower extremity infections, bone problems, or circulatory problems.
Angiogram: If the vascular surgeon determines that
the patient has poor circulation in the lower extremities, an angiogram may be performed in preparation for surgery to improve
With an angiogram, a catheter is inserted through the artery
in the groin and dye is injected while x-rays are taken. This allows the surgeon to see where the blockages are and plan an operation to bypass the blockages. This procedure is usually performed with local anesthesia and a light sedative given through
a tube inserted in the patient's vein (an intravenous or IV line).