Examine the patient in supine position and continually compare left and right.
Temperature
Using the backs of both hands, thoroughly palpate all extremities symmetrically, including toes/fingers, on all sides.
A decrease in temperature can be indicative of an arterial circulatory disorder. An increase in temperature can be indicative of inflammation or venous thrombosis.
Fluid retention
Press pretibially for about 10 seconds with the thumb on the periosteum and look and feel whether a cavity develops (pitting oedema). If necessary do this in the perimalleolar region and on the dorsum of the foot.
Pitting oedema occurs, for example, in the case of circulatory volume overload (congestive heart failure) or in the case of local venous drainage obstruction. Non-pitting oedema occurs in the case of lymph drainage obstruction.
Skin elasticity measurement
Take a fold of skin between the thumb and index finger and slide it backwards and forth several times. Normally the skin returns immediately to its original shape. If a fold remains then there is reduced skin turgidity. This can occur in the case of a local circulatory disorder but also in the case of systemic underfilling (e.g. dehydration). In the case of lymph oedema no skin fold can be observed on the upper foot.
Skin compliance measurement
Slide the hand ventrolaterally and ventromedially with the middlemost 3 fingers pressed firmly together with respect to the underlying layer and assess the thickness and consistency of the subcutis and muscle layer. A decrease in the subcutaneous and muscle layer can be indicative of arterial insufficiency.
Capillary refill
Compress the skin in an area suspected of vascular pathology until it turns white. Upon being released, count/measure how long it takes the skin to regain its pink colour.
Normally this will happen within 5 seconds. If this takes longer, it may indicate a disorder in the local or systemic arterial circulation. [Figure 24]
Figure 24: Capillary refill