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In evaluating the patient with a diabetic foot ulcer, the health care provider will pay close attention to the following clinical parameters:

• Characteristics of the ulcer:

  • Appearance, location and size of the ulcer
  • Depth of the ulcer - using a special "probe", the doctor can measure how deep the ulcer has spread. In general, deeper ulcers pose a higher risk for developing cellulitis and/or osteomyelitis than superficial ulcers and, therefore, require more aggressive treatment

• Infection

  • Inspecting the ulcer for clinical signs of infection (pus; foul odor; swelling; redness)
  • If infection is suspected, the ulcer should be cultured and sent to the microbiology laboratory to identify the bacterial species causing the infection
  • If infection is suspected in a deep ulcer, X-rays should be obtained to determine if the infection has spread to the underlying bone (osteomyelitis). A bone biopsy is usually necessary, however, to confirm the diagnosis of osteomyelitis

• Peripheral neuropathy

  • Screening test to determine if the patient has sensory nerve dysfunction caused by peripheral neuropathy

• Peripheral vascular disease

  • Palpation of foot pulses (e.g., pedal pulses; popliteal pulses) to screen for peripheral arterial disease