General Appearance

• Body habitus (obesity or weight loss), central adiposity, pigmentation (haemochromatosis), endocrine facies (Cushing’s, acromegaly), and injection sites.

Vital Signs

• Blood Pressure – Postural variation
• Heart Rate
• Respiratory rate
• Temperature – may be elevated in secondary infection
• BMI – likely elevated
• BSL – likely elevated

Legs

Inspection

• Structural foot deformities: bunions, hallux valgus, pes-cavus, claw toes, loss of transverse arch
• Vascular- pedal oedema, thin atrophic and shiny skin, loss or absence of hair, thickened nails, venous stasis changes and skin discolouration
• Infection- fungal nail infections, look in between toes, boils, cellulitis
• Neuropathic- dry skin, calluses and ulcers, neuropathic (Charcot’s) joint, wasting of quadriceps
• Specific skin manifestations: Necrobiosis lipoidica diabeticorum (yellow-brown, plaques with central atrophy over shins, surrounded by red margins if active), diabetic dermopathy (pigmented scars over shin), Injection sites for fat atrophy or hypertrophy