Diabetic Foot Ulcers Flashcards
Neuropathic/Diabetic ulcers - etiology
combination of factors:
- neuropathy
- ischemia
- structural changes
Regarding the etiology of neuropathic/diabetic ulcers, neuropathy, ischemia, and structural changes lead to
abnormal pressure points and repeated trauma
80% of diabetes related amputations in the US follow a
foot ulceration
What percentage of diabetes related amputations in the US follow a foot ulceration?
80%
50% of pts with diabetes related amputations will develop what? Within what time frame will this happen?
contralateral foot ulceration; 18 months
What percentage of pts with diabetes related amputations will develop a contralateral foot ulceration?
50%
Neuropathic/Diabetic ulcers - risk factors
- Hx of diabetes
- Poor glucose control
- Loss of protective sensation
- Failure to accommodate abnormal foot shape and progressive shape changes
- Decreased cutaneous microcirculation
Types of neuropathy
- Peripheral
- Autonomic
- Proximal
- Focal
According to the ADA, what percentage of people with diabetes have mild to severe forms of nervous system damage?
60-70%
According to the ADA, 60-70% of people with diabetes have
mild to severe forms of nervous system damage
Sensory Neuropathy - test for loss of protective sensation
- 10g monofilament
- test both feet
Sensory Neuropathy - test for vibratory
- tuning fork - great toe and malleolus
Sensory Neuropathy - test for reflexes
absent or diminished
- ankle
- knee
Sensory Neuropathy - test for temperature
hot/cold
Sensory Neuropathy - test for
- loss of protective sensation
- vibratory
- reflexes - absent or diminished
- temperature
Autonomic neuropathy - trophic changes
- toenails
- anhydrosis
Charcot’s aka
Neuropathic Osteoarthropathy
Neuropathic Osteoarthropathy aka
Charcot’s
Motor Neuropathy
- Bony deformities
- Decreased ROM
- Decreased strength
- Loss of balance and coordination affecting gait
With a motor neuropathy, what bony deformities are typically seen?
claw or hammer toes
With a motor neuropathy, where is decreased ROM typically seen?
- toes
- ankle
What is used to grade diabetic ulcers?
Wagner Scale
Factors leading o diabetic foot infection
- immunopathy
- angiopathy
- neuropathy
Common diabetic foot complications
- osteomyelitis
- Charcot’s foot
- infection
Diabetic Tests and Measures - Osteomyelitis
- ulcer > one month old
- probe to bone or bone is palpable
- recurrent ulcer in same location
- nonhealing with aggressive tx or worsening
Diabetic Tests and Measures - Diagnostics (Osteomyelitis)
- Sedimentation rate
- X-ray
- MRI
- Bone Scan
- Tagged WBC Study
Diabetic Tests and Measures - Treatments (Osteomyelitis)
- Antibiotics (oral or IV)
- Amputation
Diabetic ulcer plan of care
- Glucose control
- Nutrition
- Off-loading
- Optimize vascular supply
- Foot care
- Debridement
- Infection control
- Moist wound care
Protocols for diabetic foot ulcers
- Evaluate for ischemia
- Exclude presence of osteomyelitis
- Perform sharps debridement
- Provide moist wound healing
- Provide essential off-loading
- Reevaluate after 4 weeks
Diabetic Tests and Measures - Glucose Levels
- Essential for wound healing and prevention of progressive diseases associated with diabetes
- may be elevated with infection or when taking antibiotics
What is a “normal” glucose level?
< 200 mg/dl
What glucose level should be encouraged for tight control?
80-120 without highs and lows during the day
What is the mechanism of the HgA1C test?
Measures the average blood glucose levels over 2-3 months. If glucose levels are chronically high, more glucose will bind to RBC.. Normal is 4-6.1%
What is the essential HgA1C value for wound healing?
Less than 8%
What kinds of orthotics and Prosthetics are available for diabetics?
- Shoe inserts
- Walking CAM boots
- Surgical Shoes
- Rocker-bottom shoes
- 3D wafer boots
- Felt padding
- diabetic shoes
- Darco shoes
- Therapeutic shoes
- Total contact casting
- Posterior Walking Splint
What are some essential considerations for footwear?
- Good fitting
- No slippage
- Moisture control
What are physical therapy considerations for diabetics?
- Assistive devices
- Weight Bearing Status
- Mobility Training (Ambulation
- Modalities
Name aspects of foot care for diabetics.
- Daily foot inspection Wash and dry feet daily - Moisturize except between toes - Never go barefoot - Toenail care - no bathroom surgery - Shoe inspection - Buying shoes - Wear clean, white socks No foot soaks, hot water bottles, heating pads, or ice
What does podiatry involve?
- Foot and Nail care
- Fungal infections
- Debridement of hyperkeratosis
- off-loading
- surgical intervention
Disease Process
- Glycemic control
- Pulmonary function
- Smoking cessation
- Incontinence control
- stress management
Vascular Needs
- Angioplasty
- Venous Repair
- Exercise and Ambulation
- Foot care
- Podiatry
- Medication
Disease process
- Glycemic Control
- Pulmonary function
- Smoking cessation
- Incontinence control
- Stress management
Long Term Goals Documentation
- Loading on a body part is decreased
- Protection of a body part is increased
- Tolerance to activities is increased
- Weight bearing status is improved
- Awareness and use of community resources is improved
