Diabetic foot

Question 1

diabetic foot exam - inspection

Answer 1

athlete’s foot/staph between toes

Question 2

diabetic foot exam - palpation

Answer 2

CRT + pulses

Question 3

diabetic foot exam - sensation + reflexes

Answer 3

1) light touch: finger, cotton wool or monofilament - "loss of protective sensation"
avoid pinprick + neurotips
2) vibration
(these are the first 2 to go)
3) ankle jerks
4) proprioception
5) temperature

Question 4

why do diabetic feet have dry skin?

Answer 4

autonomic neuropathy with loss of sympathetic supply to sweat glands

Question 5

buzz-phrase for describing diabetic foot pathophysiology

Answer 5

loss of protective sensation leads to injury

Question 6

arterial ulcers - what are they like OE? associated features?

Answer 6

small + painful over pressure points - back of heel, plantar aspect of big toe
punched out
lateral malleolus common

assoc cold foot, absent pulses, decreased ABPI

Question 7

venous ulcers - OE

Answer 7

typ medial calf/ankle - medial malleolus - where great saphenous starts
assoc skin changes

Question 8

what is a CI to arterial ulcers?

Answer 8

compression bandaging - would compress already bad artery - must check ABPI

Question 9

venous ulcer - treatment

Answer 9

compression bandaging

Question 10

PAD - mgmt

Answer 10

STOP SMOKING
supervised exercise - can be as good as angioplasty

1) clopi, 80mg atorva, BP + DM control
2) some rogue vasodilators
3) angioplasty ± stent
4) surgical reconstruction/bypass
5) amputation

Question 11

what scars does an aorto-bifemoral bypass graft leave? what is the op for? what is it?

Answer 11

bilateral common iliac stenosis - bypass both of them and go straight to femorals from aorta

midline abdo scar
bilateral femoral artery scars

Question 12

femoro-popliteal bypass graft - what is it, what for, where scars

Answer 12

occlusion in superficial femoral. bypass it and go straight from common femoral to popliteal
scars - femoral + medial bottom of thigh