**2.2 Vascular**

Palpation of the dorsalis pedis and posterior tibial is part of the vascular examination. Because the dorsalis pedis artery is missing or diminished in size in the majority of diabetes individuals, a palpable pulse cannot be felt. The capillary refill time to each digit is also essential in determining blood flow to the toes and the microvasculature's state. Peripheral oedema may be indicative of autonomic neuropathy caused by venous blood insufficiency in the lower extremities. The lower legs have dark discolouration up to the mid-tibia [18].

#### **2.3 Neurologic**

The neurologic evaluation involves testing the patellar and Achilles deep tendon reflexes. The loss of the Achilles reflex is a sign of severe peripheral neuropathy.

*Insight of the Pathophysiology of Diabetic Foot Ulcer DOI: http://dx.doi.org/10.5772/intechopen.108190*

Sensitivity is assessed for vibratory loss using a 128 Hz tuning fork, while sensation to light touch is determine using microfilament, pin prick and temperature (tuning fork placed in warm or ice water then applied to dorsum of foot and positional sense in the toes). Neuropathy is characterised by decreased proprioception and a loss of light touch. Balance issues will be revealed by gait analysis. Walking from heel to toe might be challenging with peripheral neuropathy. A patient's larger base of gait may suggest lack of proprioception, and balance may be considerably reduced with the eyes closed. The Romberg test (loss of balance with feet together and eyes closed) is also used when evaluating neuropathy [19].
