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Diabetic Exam
 
 

Leg Colour

 
 
 
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Overview

Inspection of the colour of the lower limbs in diabetics can suggest the presence of arterial insufficiency, venous insufficiency or infection.

Lower Limb Erythema

  • Look For

  • Redness - unilateral, bilateral, localised or diffuse.
  • Causes of Lower Limb Erythema

  • CellulitisTender, red, swollen, warm calf ± site of injury
  • Skin conditionsMacules, papules, patches or plaques - localised / diffuse
  • Lipodermatosclerosis (fibrosis of subcutaneous fat)Inverted bowling pin appearance with erythema / induration
  • LymphoedemaNon-pitting oedema, usually bilateral
  • Deep venous thrombosisRed, swollen, tender calf
  • Superficial ThrombophlebitisTender area with erythema tracking along the course of a superficial vein
  • Venous insufficiencyHyperpigmentation that may be associated with varicose veins or oedema.
  • Dependent rubor(peripheral arterial disease)Dusky-red discolouration when the leg is elevated above the heart

Pallor of the Lower Limb

  • Look For

  • Loss of colour in one or both lower limbs.
  • Causes of Pallor of the Lower Limb

  • Anaemia
  • Peripheral arterial disease
  • Compartment syndrome
  • Low cardiac output, due to cardiac disease
  • Peripheral shutdown, due to increased sympathetic activity

Lower Limb Cyanosis

  • Look For

  • Blue discolouration of the lower limb.
  • Significance

  • Nail bed cyanosis is a type of peripheral cyanosis, or high levels of deoxygenated haemoglobin (hypoxaemia) in the peripheries. Always look for central cyanosis (under the tongue) when this is present.
  • Causes of Lower Limb Cyanosis

  • Central Cyanosis

  • High altitude
  • Obstructive lung disease, pulmonary oedema, pneumonia, pulmonary embolism
  • Congenital heart disease
  • Methaemoglobinaemia / sulfhaemoglobinaemia / carboxyhaemoglobinaemia
  • Peripheral Cyanosis

  • As for central cyanosis
  • Reduced cardiac output
  • Vasoconstriction
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