**2. Evaluation and diagnosis of DFU**

Diabetic patients need to regularly check their foot from any sign of ulcer and infection. A typical foot examination encompasses four aspects which are dermatologic, vascular, neurologic and musculoskeletal.

## **2.1 Dermatologic**

The dermatologist will look for any thickness or discolouration of the toenails, as well as hyperkeratosis on the toes or balls of the feet. The state of the patient's skin reveals information regarding the health of the patient's feet. Toenails that are excessively swollen, opaque, disintegrating, yellow in colour and malodorous are most likely fungal, indicating sensory, autonomic or both neuropathies. Peripheral neuropathy dulls the sensation and allows patients to bear more sustained pressure on a small region of skin without experiencing pain. Shear pressures induce the skin to react to aberrant stimuli, causing keratinisation to rise. Autonomic neuropathy makes it difficult to maintain normal skin moisture balance and control. The skin becomes either too dry and scaly or too wet, promoting dermatophyte infections and skin maceration inside the webspaces [9, 16, 17].
