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Pathophysiology

1. Microvascular neuropathy
2. Peripheral macrovascular disease
3. Infection 

Approach

• Expose from groin to toes
• Preserve dignity

1. Inspect
   • Any sign of vascular disease
   • Presence of bilateral disease
   • Previous surgical scars including toe amputations for ischaemic gangrene
   • Charcot's joints
   • Signs of damage to foot if patient has a sensory neuropathy and cannot feel injuries such as hot bath-water
2. Palpate
   • Pulses may be preserved until later in disease: Calcification of wall of vessels preserves pulses (also prevents sphygmomanometer from comrpessing the vessels - leads to abnormally high ABPI)
   • Test sensation over foot

Completion

1. Neurological examination
2. Examine abdomen, rest of peripheral vascular system, fundoscopy, dipstick urine (protein, DM, microalbuminaemia)