Chapter 114 - Diabetic foot abnormalities

Question 1

Rate of foot ulcer in diabetic per year

Answer 1

5.8 - 7.1%

Question 2

Epidemiology of diabetics higher risk of amputation

Answer 2

1) minority population 2x 2) men 2x

Question 3

Small sensory fiber neuropathy symptoms

Answer 3

1) burning 2) tingling 3) radiating electrical shocks

Question 4

Large sensory fiber neuropathy symptoms

Answer 4

1) numbness 2) tingling 3) formication tunning fork, monofilament, Achilles deep tendon reflex tests

Question 5

Autonomic peripheral neuropathy symptoms

Answer 5

1) AV shunt 2) small vessel ischemia 3) change soft tissue turgur (xerosis, dry, non elastic, fissure)

Question 6

Motor neuropathy symptoms

Answer 6

1) muscle atrophy 2) imbalance of opposing muscle group 3) joint laxity and bone mal-alignment 4) structural foot deformity

Question 7

hallux abductovalgus

Answer 7

valgus deformity of the first toe

Question 8

common biomechanical abnormalities in DF

Answer 8

TABLE 114.1

Question 9

Treatment of diabetic neuropathy

Answer 9

1) glucose control 2) antidepressant, narcotic, antiarrhythmic, anticonvulsant 3) vitamin, l-methylfolate, methylcobalamin, pyridoxal 5’ phosphate 4) topical clonidine and capsaicin 5) surgical decompress peroneal and tibial nerve 6) proper shoe fitting

Question 10

Two types of biomechanical forces that result in ulcer formation

Answer 10

1) saggital plane 2) shear forces

Question 11

Reducibility of malaligned joint articulation classification

Answer 11

Reducible semi-reducible non-reducible

Question 12

Treatment of diabetic foot biomechanics

Answer 12

1) pressure offloading (padding, orthotics, braces) 2) rocker bottom shoes 3) seamless inners, inserts 4) total contact cast 5) walker boot/healing shoe 6) airbladder, foam when supine TABLE 114.2

Question 13

Surgical correction of biomechanic problems

Answer 13

TABLE 114.2

Question 14

Bacterial biofilm component

Answer 14

Glycocalyx shell

Question 15

Antiotic doesn’t work on biofilm because

Answer 15

Low metabolic activity of biofilm

Question 16

Fundamentals of wound care in dfu

Answer 16

1) perfusion 2) offload 3) infection/biofilm 4) metabolic/nutritional status

Question 17

DFU treatment strategies

Answer 17

TABLE 114.3

Question 18

Rate of charcot neuroarthropathy in diabetes

Answer 18

0.5%

Question 19

Symptoms of charcot

Answer 19

1) edema 2) erythema 3) calor 4) fractures 5) dislocation

Question 20

Pathophysiology theory of Charcot

Answer 20

1) demineralization of bone causing instability

Question 21

Stages of Charcot Neuroarthropathy

Answer 21

STAGE 1: fragmentation/destruction, bony cyst, erosion STAGE 2: joint subluxation STAGE 3: arch collapse and coalescence STAGE 4: consolidation

Question 22

Major amputation rate of charcot foot

Answer 22

32%