Diabetes

Question 1

A patient has a neuropathic ulcer with dry, cracked skin and a history of poor glycemic control. What interventions are essential to promote healing?

Answer 1

Interventions: Tight glycemic control, aggressive debridement, off-loading with a total contact cast or appropriate footwear, and addressing dry skin with moisturizers.

Question 2

How would you modify interventions for a patient with neuropathic ulcers and sensory neuropathy who cannot feel the 10g monofilament test?

Answer 2

Modifications: Emphasize off-loading to prevent unnoticed trauma, ensure caregiver involvement for foot inspections, and educate on daily protective measures.

Question 3

A patient with a Wagner grade 1 ulcer has been prescribed a total contact cast. What are the contraindications to consider?

Answer 3

Contraindications: Osteomyelitis, gangrene, fluctuating edema, active infection, or an ABI less than 0.45.

Question 4

A patient presents with recurrent ulcers despite off-loading interventions. What additional evaluations should be performed?

Answer 4

Evaluate for vascular insufficiency, infection, foot deformities, and compliance with the care plan.

Consider revascularization or corrective surgery if needed.

Question 5

How do motor neuropathy and autonomic neuropathy contribute to the development of diabetic foot ulcers?

Answer 5

Motor neuropathy: Causes intrinsic muscle atrophy, leading to foot deformities and increased pressure.

Autonomic neuropathy: Leads to dry, cracked skin and impaired vasodilation, reducing tissue perfusion.

Question 6

A diabetic patient with Charcot foot is in the acute phase. What are the priorities for intervention?

Answer 6

Control inflammation, immobilize the foot with a total contact cast or CROW boot, and prevent further trauma or deformity.

Question 7

What steps would you take to educate a patient with recurrent diabetic ulcers on daily foot care?

Answer 7

Steps: Teach daily foot inspection, proper nail and skin care, appropriate footwear selection, and the importance of glycemic control and off-loading techniques.

Question 8

What are the common locations of neuropathic ulcers?

Answer 8

Locations:

• plantar aspect of metatarsal heads
• tips of toes
• plantar midfoot in Charcot deformities
• areas of pressure/friction from improper footwear

Question 9

What is the 5PT method for characterizing neuropathic ulcers?

Answer 9

Pain: Absent or reduced due to neuropathy.
Position: Plantar surface, under calluses, or at pressure points.
Presentation: Round, punched-out lesions with minimal drainage unless infected.
Periwound: Dry, cracked skin with callus formation.
Pulses: Normal or accentuated with vessel calcification.

Question 10

What structural changes occur in the periwound area of neuropathic ulcers?

Answer 10

Changes: Dry, cracked skin; callus formation; claw toes; rocker-bottom foot; prior amputations or deformities.

Question 11

How does vascular disease contribute to delayed healing in neuropathic ulcers?

Answer 11

Mechanism: Accelerated atherosclerosis and thickened basement membrane impair blood flow, reducing oxygen and nutrient delivery to tissues.

Question 12

What are the key skin changes in diabetic wounds?

Answer 12

Changes: Cracking, callus formation, decreased collagen deposition, inhibited fibroblast activity, and delayed epithelialization.

Question 13

What are the risk factors for neuropathic ulcers related to mechanical stress?

Answer 13

Factors: High plantar pressures, improper footwear, and abnormal foot biomechanics such as toe deformities or plantar flexion contractures.

Question 14

What are the typical presentations of neuropathic ulcers in diabetic patients?

Answer 14

Presentation: Even wound edges, well-defined borders, and minimal drainage unless infected.

• Eschar is uncommon unless infected.

Question 15

What are the implications of autonomic neuropathy in neuropathic ulcer development?

Answer 15

Implications: Dry, cracked skin due to decreased sweating, increased callus formation, and impaired vasodilation leading to reduced tissue perfusion.

Question 16

How do impaired healing and immune response affect diabetic wound healing?

Answer 16

Effects: Reduced ability to build new tissue, increased susceptibility to infections, and impaired progression through wound healing phases.

Question 17

What is the prognosis for neuropathic ulcer healing, and what factors influence it?

Answer 17

Prognosis: Healing takes an average of 12–14 weeks.

• Influencing factors include glycemic control, off-loading adherence, and management of comorbidities.

Question 18

What is the definition of diabetes, and what are its primary types?

Answer 18

Definition: A group of metabolic diseases with prolonged high blood sugar levels.

Types:

• Type 1 (autoimmune destruction of beta cells, no insulin production)
• Type 2 (insulin resistance, often linked to obesity).

Question 19

What are the acute and long-term complications of diabetes?

Answer 19

Acute complications: Diabetic ketoacidosis, nonketotic hyperosmolar coma.

Long-term complications: Heart disease, stroke, kidney failure, neuropathic ulcers, and visual impairment.

Question 20

How does hyperglycemia contribute to tissue damage in diabetic patients?

Answer 20

Mechanisms: Alters RBCs and capillaries, increases microvascular pressure, and causes glycosylation of proteins, leading to tissue trauma and destruction.

Question 21

What are the primary risk factors contributing to neuropathic ulcers?

Answer 21

Risk factors: Vascular disease (PVD), neuropathy (sensory, motor, autonomic), mechanical stress, poor footwear, impaired healing, and poor glycemic control.

Question 22

How does sensory neuropathy increase the risk of diabetic ulcers?

Answer 22

Mechanism: Loss of protective sensation allows unnoticed trauma and pressure to cause ulcers. Paresthesia further complicates detection.

Question 23

What are the impacts of motor neuropathy on diabetic foot health?

Answer 23

Impacts: Muscle atrophy leads to foot instability, deformities, and increased pressure and shear forces on the foot.

Question 24

What is the significance of autonomic neuropathy in diabetic foot care?

Answer 24

Significance: Causes dry, cracked skin, impaired sweating, and reduced perfusion due to vasodilation issues, increasing ulcer risk.

Question 25

What role does mechanical stress play in the development of neuropathic ulcers?

Answer 25

Excessive forces, high plantar pressures, and improper footwear lead to tissue overload and ulceration.

Question 26

How can patient education reduce the risk of diabetic foot ulcers?

Answer 26

Education: Focuses on daily foot inspection, proper footwear, glycemic control, and adherence to off-loading techniques to prevent trauma.

Question 27

What are the goals of physical therapy interventions for diabetic ulcers?

Answer 27

Goals: Improve glycemic control, reduce pressure with off-loading, enhance circulation, and facilitate wound healing through proper dressing and debridement.

Question 28

What is total contact casting, and when is it used?

Answer 28

Definition: A molded cast that redistributes weight-bearing forces, controls edema, and protects ulcers. Indications: Wagner grade 1 or 2 ulcers.

Question 29

What are the contraindications for total contact casting?

Answer 29

Contraindications: Osteomyelitis, gangrene, fluctuating edema, active infection, or an ABI less than 0.45.

Question 30

What devices are used for off-loading in diabetic foot care?

Answer 30

Devices: Total contact casts, CROW boots, wedge shoes, rocker-bottom shoes, and prefabricated cast walkers.

Question 31

What is the purpose of a wedge shoe, and how does it function?

Answer 31

Purpose: Reduces forefoot or heel pressure. Function: Shifts weight to midfoot or opposite side to promote healing after trauma or surgery.

Question 32

What are the essential features of permanent footwear for diabetic patients?

Answer 32

Features: Extra-depth toe box, soft moldable materials, proper length and width, and low heel height (<1 inch).

Question 33

How is glycemic control monitored, and why is it important in wound healing?

Answer 33

Monitoring: HbA1c provides an aggregate glucose level over 2–3 months. Importance: Better control reduces infection risk and improves healing rates.

Question 34

What are the benefits of aerobic exercise for diabetic patients?

Answer 34

Benefits: Enhances glycemic control, promotes weight loss, and improves circulation, aiding wound healing.

Question 35

What wound care techniques are essential for diabetic ulcers?

Answer 35

Techniques: Debridement, use of antimicrobial dressings for infection, moisture balance in dressings, and padding to protect wounds.

Question 36

What are the indications for surgical intervention in diabetic foot care?

Answer 36

Indications: Debridement of necrotic tissue, correction of foot deformities, revascularization, or amputation in severe cases.

Question 37

How does poor vision impact diabetic foot care?

Answer 37

Impact: Increases risk of unnoticed trauma and reduces the ability to perform effective foot inspections and care.

Question 38

What is the role of orthotics in diabetic foot care?

Answer 38

Role: Corrects foot deformities, redistributes pressure, and prevents ulceration in high-risk areas.

Question 39

What are the clinical signs of infection in diabetic ulcers, and how should they be managed?

Answer 39

Signs: Increased drainage, redness, warmth, and delayed healing. Management: Culture and sensitivity testing, appropriate antibiotics, and surgical intervention if needed.

Question 40

What are the risks of delayed treatment for neuropathic ulcers?

Answer 40

Risks: Progression to infection, osteomyelitis, amputation, and systemic complications affecting overall quality of life.

Question 41

What are the key steps in creating a treatment plan for a diabetic foot ulcer?

Answer 41

Steps: Glycemic control, off-loading, wound debridement, appropriate dressings, and patient education on preventive care.