diabetic foot Flashcards
diabetes facts
Greatest risk for diabetic foot ulcer (DFU) is neuropathy
15% of those with diabetes with have DFU
Greatest risk for amputation is a DFU
Diabetic amputations > 3.3/1000 according to the CDC
25-68% incidence of contralateral amputation within 3-5 years
50% three year mortality rate
Each amputation costs $25,00-$40,000
impaired healing and immune response
Hyperglycemia causes tissue Damage
Altered ability to build new tissue
Altered ability to fight infection
Sustained hyperglycemia decreases all 3 phases of wound healing
Decreased rate of:
Collagen synthesis
Angiogenesis
Fibroblast proliferation
Tensile strength of incisional wounds
risk factors
Interrelated/cumulative
PVD
Neuropathy (polyneuropathy)
Sensory
Motor
Autonomic
Mechanical stress
Impaired ROM
Foot Deformities
Previous Ulcer or Amputation
Inadequate Footwear
Impaired Healing and Immune Response
Poor vision
do all pts with DM have poor circulations
Not necessarily
DFU are a result of :
Neuropathy
Mechanical stress
+/- PVD
neuropathy
Most common complication
30-40% affected (Type 2); higher with Type 1
Symmetrical
affects distal nerves first
May be caused by neural ischemia or segmental demyelinization
Incidence and severity increase with age and duration of disease
sensory neuropathy
Inability to perceive trauma to the feet
Sensory loss occurs gradually and is painless
Patients may be unaware
Paresthesias
5.07 Semmes-Weinstein monofilament=10 grams of pressure =protective sensation
motor neurpathy
Paralysis of intrinsic muscles= muscle imbalances
Alters weight bearing patterns
Increases plantar pressures and shear forces
Excessive plantar pressure and shear forces on metatarsal heads
Loss of intrinsic function-foot less stable during stance
Decreased ROM
Deformity
Muscle imbalances-
hallux valgus and claw toe deformities
metatarsal heads more prominent
more pressure during weight bearing
charcot foot
Loss of sensation, often not recognized early, disruption of bony structures- sublux, bony fragments
autonomic neuropathy
Alterations in
Sweating mechanisms (hydration)
Callus formation
Blood flow (vasomotor regulation)
abnormal foot function and inadeqate footwear
Impaired motion
Foot deformities
Previous ulcer or amputations
Combine with poor footwear and decreased sensation…..
foot deformities
Plantar flexion contractures
Forefoot varus/valgus
Neuropathic fractures and dislocation= Charcot foot
Combined with sensory neuropathy = increased ulceration risk
previous ulcer or amputation
Altered skin performance
Less elastic
Decreased strength
Altered foot structure from amputation
Predisposing factors causing old injury still present
neuropathic ulcers
Associated with
Morbidity
Mortality
Financial burden
25 X > Lower extremity amputations in diabetic people
600,00 annually (80% after foot ulcer)
More than ½ get 2nd amp within 3-5 years
wagner classification of diabetic foot ulcers
Grade 0: No ulcer in a high risk foot.
Grade 1: Superficial ulcer involving the full skin thickness but not underlying tissues.
Grade 2: Deep ulcer, penetrating down to ligaments and muscle, but no bone involvement or abscess formation.
Grade 3: Deep ulcer with cellulitis or abscess formation, often with osteomyelitis.
Grade 4: Localized gangrene.
Grade 5: Extensive gangrene involving the whole foot.
PT intreventions
Co-ordination
Communication
Documentation
Education (patient)
Individualized procedural interventions
interventions specific to wound
Offload
Remove callus
Stabilize blood sugar
interventions
Local wound care
Debride callus to be flush with epithelial surface
Daily moisturization
Not between toes
If enclosing toes with a bandage
Spacers between toes
Absorb moisture
Provide padding
Reduce shearing
footwear
Assess shoes in relation to feet
Toe box adequate
Shoe length appropriate
Leather uppers
Adequate width through forefoot
Contact of shoe last with arch of foot
Low heels
charcots arthropathy: treatment
Bottom Line:
If not recognized and treated early, Charcot can result in devastating changes to the architecture of the foot. Therefore, any unexplained swelling in the foot of a patient with diabetes in the absence of an open wound should be treated as Charcot until proven otherwise.
relief pads, wedge shoes, semmes-weinstein monofilament testing
