Inspection:
- gross deformity (gangrene, amputation, ulceration)/ wasting of muscles
- ulcers site over pressure area (heel, 5th metatarsal head, toewebs)
- trophic changes (loss of hair, brittle skin)
- scars (femoral, medial thigh, abdominal)
Palpation:
- tempoerature (cold)
- tenderness
- cappilary refill
- pulses
- dorsalis pedis (just lateral to extensor hallux longus at mid foot)
- posterior tibial (mid point of medial malleolus and heel)
- popliteal (deepest in popliteal fossa - push it aagainst tibia)
- femoral (mid inguial point = ASIS to pubic symphysis)
Auscultation:
- femoral
- adductor hiatus (1/3 above knee at medial thigh)
- abdominal aorta
- renal arteries
Completion:
- buerger's test (raise leg, watch sole)
- ankle-brachial pressure index (ankle / brachial. 0.5 = critial ischaemia)
- full cardiovascular examination
look for cause of ischaemia
- thromboembolic disease (eg. AF, AAA)
- trauma (scars)
- peripheral vascular disease risk factors (smoking, diabetes)
