Diabetic Foot Care Lecture Powerpoint

Question 1

“The Perfect Storm” 4 components resulting in diabetic foot ulcers

Answer 1

• vascular disease
• neurological damage
• infection
• trauma

Question 2

Risk factors for foot ulcers (4)

Answer 2

• anatomic foot deformity
• previous foot ulcer
• peripheral vascular disease
• diabetic nephropathy

Question 3

International working group on diabetic foot classification (4)

Answer 3

Group 0: no evidence of neuropathy
Group 1: neuropathy present but no evidence
Group 2: neuropathy with evidence of deformity or peripheral vascular disease
Group 3: history of foot ulceration of lower extremity

Question 4

Big issue is that clinicians do not do what when examining diabetic patients?

Answer 4

They ignore the foot exam

Question 5

5 P’s of arterial insufficiency

Answer 5

• Pain
• pulseless
• paresthesias
• paralysis
• pallor
• poikilothermia (rare 6th P)

Question 6

Noninvasive screening for peripheral artery disease (2) and invasive (2)

Answer 6

• Ankle brachial index
• ultrasound
• CTA
• MRA

Question 7

Treatment for arterial insufficiency (2)

Answer 7

• Bypass grafting

- amputation (remove to the level of most viable tissue)

Question 8

__% of individuals with one amputation due to peripheral arterial disease will develop ___ on the other side within 2 years

Answer 8

50, gangrene

Question 9

Diabetic neuropathy pathophysiology

Answer 9

-Segmental demyelination brought on by uncontrolled high blood sugar made worse in the distal nerves affecting the corticospinal, dorsal column, and spinothalamic tracts

Question 10

Early (2) and late sensory symptoms of diabetic foot neuropathy (5)

Answer 10

Early
-night cramps
-paresthesia
Late
-loss of touch
-deep pain
-loss of position sense
-anesthesia
-loss of deep tendon reflex

Question 11

Common history findings of neuropathy in diabetic patients (3)

Answer 11

• long term diabetes
• poorly controlled diabetes
• comorbidities associated with their diabetes

Question 12

Treatment of diabetic neuropathy (4)

Answer 12

• Debridement of the wound
• antibiotics
• orthotics
• insulin/diabetic treatment

Question 13

Charcot foot definition and mech of action

Answer 13

Condition causing weakening of bones of the foot frequently associated with significant nerve damage from something like a diabetic neuropathy

• denervation of small foot muscles due to neuropathy
• weakness of muscle resulting
• disarray of bony structures
• atrophy of leg and foot muscles
• altered weight distribution causes callus, ulcers, pes cavus, and charcot foot

Question 14

Pes cavus

Answer 14

High arch of foot with fixed plantar flexion that can result from altered weight distribution due to significant nerve damage from something like a diabetic neuropathy

Question 15

Locations where diabetic foot ulcers frequently form (3)

Answer 15

• pressure points
• areas of trauma (susceptibility to bacteria)
• areas of decreased sensations and vascular supply

Question 16

Wagner system of classification of ulcers (4) and then staging (4)

Answer 16

Grade 0: pre or post ulcerative (just beginning or at the end)

1: full thickness ulcer not involving tendon, capsule or bone
2: tendon or capsular involvement without bone palpable
3: probes to bone

Stage A: noninfected
B: infected
C: Ischemic
D: infected and ischemic

Question 17

Septic foot presentation (5)

Answer 17

• cool clammy skin
• altered mental status
• hypotension
• tachycardia
• tachypnea
• High WBC count

Question 18

Septic foot treatment (2)

Answer 18

• Broad spectrum antibiotics and cultures to eventually steer treatment direction
• surgery (extensive debridement, wound culture)

Question 19

Septic foot Labs (5)

Answer 19

• Xray or CT if osteomyelitis suspected
• CBC
• CRP or ESR
• Blood cultures
• BUN/Creatinine

Question 20

Diabetic patient foot care principles to prevent ulceration (3)

Answer 20

• educate patient on controlling blood glucose
• encourage frequent foot care including drying between the toes and such
• looking at foot with a mirror frequently