Table 3.

Lower limb physical examination

Dermatologic examination	• Color, turgor, wetness, hair growth, chap
	• Nail atrophy or hypertrophy
	• Calluses and subcallus hemorrhage
	• Ulcers (location, size, depth, infection status), gangrene
	• Others: (1) tinea pedis (fungal infection), paronychia (bacterial infection), itchy with scratch marks (yeast infection)，(2) microvascular change, light brown, scaly patches (diabetic dermatopathy)，(3) diabetic steatosis, bullous disease，(4) eruptive xanthomatosis, distal sclerosis, disseminated granuloma annulare (5) anaphylaxis
Vascular examination	• Absence of hair growth, onychodystrophy, thinning skin (parchment-like skin), cyanosis and erythema, postural color change
	• Temperature gradient (ipsilateral and contralateral extremity)
	• Abdominal artery to dorsal foot artery auscultation, palpation of femoral artery to dorsal foot artery
	• Handheld doppler examination
Neurologic and musculoskeletal examination	• Vibration perception: tuning fork 128 cps, biothesiometer
	• Light pressure: Semmes-Weinstein 10-gram monofilament
	• Light touch: cotton wool, two-point discrimination
	• Pain: pinprick (sterile needle)
	• Temperature perception: cold and hot
	• Deep tendon reflexes: patellar and ankle reflexes, clonus testing, Babinski test, Romberg test
	• Biomechanical abnormalities: (1) structural deformities: hammertoe, bunion, tailor’s bunion, hallux limitus, flat or high-arched feet, Charcot deformities, postsurgical deformities (including prior amputation); (2) limited joint mobility; (3) plantar pressure assessment: callus, corns, skin pressure red and other manifestations, computerized devices, Harris ink mat, pressure sensitive foot mat