Ask patient to expose and walk – look at the gait 
 
then inspect – 
swelling, Scars , Skin changes –  
tropic changes – with hair loss, wasting of muscels, deformity, arches chanegs with clawing, , look in to the web spaces and nail chanegs 
no charcots joints/ feet
no foot ulcers ( in DM – well demarcated punched out ulcer – in weight bearing area , +/- infection ) – need to debride dead hard tissue and put wet dressing + pressure off leading in MX 
 
Palpate – 
temperatues – 
pulses – ( popletial, PT and DP )  – normal rate and rhytham- 
CRFT 
 
neurological examination for DM 
( start with neck feeling example )  – advice what i am doing – 
10G mono filamaent – check both LL to gether – and ask equal 
Vibration – with 128 ( for webers and rennis 512)  – tell me when it stops – 
Reflexus – knee and ankle 
 
Propioception – 
Pain 
 
look for foot wear – 
Then say – ill look for fundoscopy and then urine dip stick as well 
 
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