General principles

Examine the patient first, then the wound and surrounding skin and local area, including joints. Examination can begin in the waiting room, by assessing how patients stand and move, and if they are wearing appropriate footwear.

Examine the patient for:

• vascular disease (chronic venous insufficiency, peripheral arterial disease, mixed vascular disease)
• heart and lung disease (eg breathlessness on exertion, cyanosis, signs of right-sided heart failure [eg elevated jugular venous pressure])
• anaemia (eg pallor)
• systemic infection (eg fever, tachycardia)
• lymphadenopathy
• peripheral oedema or lymphoedema
• nutritional deficiency
• dehydration
• neurological disease (eg gait disturbance that influences calf muscle pump function, impaired upper limb function, sensory or motor impairment)
• arthritis.

Throughout the examination, look out for signs of:

• impaired communication or cognitive function
• anxiety, depressed mood or other mental health concerns
• wound-related pain or distress.

Consider the patient’s standard of personal hygiene.