Exams and Tests

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 circulation.
• • 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).