Diabetic Foot Care

Question 1

what are the principle pathogenic mechanisms of diabetic foot facts?

Answer 1

• neuropathy(reduced pain and proprioception, reduced joint mobility)
• PVD (foot ischemia)
• infection
• -a combinnation of these things lead to foot ulceration.

Question 2

What is the answer to preventing all diabetes complications?

Answer 2

-TIGHT glycemic control

Question 3

Sx of:

• sensory neuropathy
• motor neuropathy
• autonomic neuropathy

Answer 3

• Sensory: nerve damage, numbness, burning, tingling, pins and needles.
• Motor: nerve damage leading to musculoskeletal deformities
• Autonomic: nerve damage leading to dry feet, feet dont sweat, cracking of feet.

Question 4

How does PVD decrease the body’s ability to fight infection and to heal wounds in the foot?

Answer 4

-lack of blood flow and oxygen to the area from ischemia

Question 5

What are some common nail deformities

Answer 5

• onychomycosis (fungus)
• onychocryptosis (ingrown toenail)
• subungual ulceration

Question 6

What are some sensory tests used to evaluate the diabetic foot?

Answer 6

• Weinstein monofilament
• significant neuropathy if unable to feel greater than 6 sites

-vibratory exam (tuning fork)

Question 7

How do we test the vascular system in the foot?

Answer 7

• paplation of foot pulses
• capillary refill testing
• doppler testing
• edematous changes

Question 8

What are some signs of arterial disease?

Answer 8

• intermittent claudication
• thin, shiny skin with lack of hair
• lack of subQ padding
• dusky/red/cyanotic/grey color

Question 9

What are some musculoskeletal deformities of the foot?

Answer 9

• high arch (Pes Cavus)
• no arch (pes planus)
• Bunions
• Claw and hammer toes
• past ulceration sites
• charcot foot

Question 10

Cellulitis:

• most commonly caused by what bacteria?
• treatment

Answer 10

-caused by strep A and B, also Staph aureus

• tx: cephalosporins, clindamycin
• debridment and flushing
• offloading
• dressing changes

Question 11

Acute osteomyelitis

• what is this?
• what is the usual bacterial cause?
• Tx

Answer 11

• infection down to the bone
• S. Aureus
• Tx:
• abx therapy
• debridement
• infectious disease consult

Question 12

Charcot Foot

-what is this?

Answer 12

-destructive arthropathy resulting from impaired pain perception and increased bone blood flow. Bone becomes washed out and weak resulting in small periarticular fx until joints become destroyed

Question 13

Signs of Charcot Foot

• most common causes
• tx

Answer 13

• Signs: painless swelling and bounding pulses
• cause: diabetes and other conditions causing neuropathy
• tx: immobilization

Question 14

Diabetic Foot Risk Classification signs of:

• low current risk
• increased risk
• high risk
• ulcerated foot/foot care emergency

Answer 14

• Low” normal sensation, pulses palpable
• increased: neuropathy or absent pulses
• high: neuropathy or absent pulses plus other risk factors
• ulcerated: ulcer present or sign of infection/charcot foot development

Question 15

General Tx of Diabetic Feet

Answer 15

• buy proper shoes, no narrow box toes
• good foot care, always be checking the feet for sores
• tight glycemic control
• if ulcer: possible abx, possible x-ray to confirm no bone involvment, non-weight bearing on foot with ulcer
• some may require amputation.