Table of Contents Suggested approach to foot ulcer osce station Describing lesionsOther aspects of examinationIf you are required to ask the patient questionsTypes of foot ulcer Possible investigation to determine cause Time for some viva questionsTry some related OSCE stations A foot ulcer is a break in skin continuity on or around the feet that may be of arterial, venous or neuropathic aetiology. Suggested approach to foot ulcer osce station Describing lesions Arterial ulcer‘There is a well-demarcated ulcer on the tip of the right great toe.’‘It has a diameter of 1cm and a punched-out appearance.’‘The ulcer has a necrotic base.’‘The surrounding skin is cool and pale, and the dorsalis pedis and posterior tibial pulses are very weak.’‘This lesion is characteristic of an arterial ulcer.’Venous ulcer‘There is a large superficial ulcer on the medial gaiter region of the right leg.’‘This has a diameter of approximately 14cm and has an irregular border.’‘The ulcer has an exudative, granulating base.’‘There is associated venous eczema and lipodermatosclerosis.’‘This lesion is characteristic of a venous ulcer.’Neuropathic ulcer‘There is a well-demarcated ulcer on the plantar aspect of the first metatarsophalangeal joint.’‘It has a diameter of 1cm and a punched-out appearance.’‘The ulcer has a granulating base.’‘The surrounding skin is hyperkeratotic and there is reduced sensation peripherally.’‘This lesion is characteristic of a neuropathic ulcer.’ Venous ulcerationNeuropathic ulcerNecrotic ulcerationTrophic changes with bilateral callous formation and early ulceration Other aspects of examination Surrounding skin (including temperature)Peripheral pulses and capillary refillPeripheral sensation If you are required to ask the patient questions Associated pain and when this is worseLoss of sensationHistory of diabetes, vascular disease, varicose veins, DVT Types of foot ulcer Possible investigation to determine cause Fasting glucose: to exclude diabetesAnkle brachial pressure index: <0.9 = peripheral vascular diseaseDuplex ultrasound: to look for peripheral vascular disease or venous incompetenceX-ray: to exclude osteomyelitisSwabs for MC&S: if signs of infection Time for some viva questions What are the 6 P’s of an acute ischaemic limb? Oops! This section is restricted to members. In what circumstance may ABPI be falsely elevated? Oops! This section is restricted to members. How would you manage venous ulceration? Oops! This section is restricted to members. Try some related OSCE stations Diabetic foot examLower limb arterial examFind more here
