Diabetic Ulcers

Question 1

Prevalence of Diabetes/ diabetic ulcers

Answer 1

20.8 million with diabetes

15% of diabetics develop ulcers

82k LE amputations per year 2* to DM

30% of people c DM over age of 40 have impaired sensation on feet

Question 2

Mortality rates associated with diabetic ulcers

Answer 2

80% of diabetic amputations 2* ulcer

50% of these get contralateral ulcer

50% get second amputation

35-50% of these die within 3 years

Question 3

Diabetic ulcer etiology

Answer 3

neuropathy-> ischemia-> structural changes

abnormal pressure points and repeated trauma

Question 4

Diabetic ulcer risk factors

Answer 4

DM
poor glucose control
loss of protective sensation
failure to accommodate abnormal foot shape
decreased cutaneous circulation

Question 5

types of neuropathy

Answer 5

peripheral
autonomic
proximal
focal

60-70% of DM pts have mild to severe nervous system damage

Question 6

Trophic changes with neuropathy

Answer 6

toenails
anhydrosis
callus can crack and get infected

Question 7

Charcot’s: neuropathic osteoarthropathy

Answer 7

increased peripheral blood flow:

sympathetic denervation

osteolysis (softening of bone)

osteopenia

Question 8

motor neuropathy

Answer 8

claw or hammer toes (claw has DIP flexion)
decreased ROM
decreased strength
loss of balance/coordination

Question 9

Wagner scale for diabetic ulcers

Answer 9

Grade 0: no open lesion, but skin changes

Grade 1: superficial ulcer

Grade 2: ulcer penetrates to tendon, bone, or joint

Grade 3: deeper than grade 2, with abscess, osteomyelitis, pyarthrosis, or infection of tenon

Grade 4: wet/dry gangrene in toes, forefoot, knee, buttocks, elbow, or fingers

Grade 5: gangrene in whole foot, hand, or hind quarter

Question 10

Angiopathy in diabetes

Answer 10

poor perfusion of blood: decreased nutrients for wound healing

macro=both LE

micro: possible sclerosis

Question 11

Diabetic affect on immune

Answer 11

impaired leukocyte function

impaired intracellular killing and impaired phagocytosis

Question 12

foot complications of diabetes

Answer 12

osteomyelitis
Chracot’s
infection

Question 13

Osteomyelitis risk factors

Answer 13

ulcer> 1 month old
probe to bone possible/bone palpable
recurrent ulcer
non-healing with treatment

Question 14

Osteomyelitis dx and treatment

Answer 14

dx: ESR, X-ray, MRI, bone scan, tagged WBC study
treatment: antibiotics (for 6 weeks) or amputation

Question 15

Charcot’s foot risk factors

Answer 15

elevated blood glucose
peripheral neuropathy
increased mechanical stress (fat or ulcer on other foot)
ankle equinus
trauma

Question 16

Acute Charcot’s s/s

Answer 16

effusion
edema
subluxation
intra-articular fx
bone fragmentation
warmth
jt laxity

Question 17

Infeciton s/s in diabetics

Answer 17

first: increased blood glucose

purulence
warmth
tenderness
pain
induration
cellulitis
bullae
crepitus
abscess
faciitis

Question 18

Glucose levels

Answer 18

may be eleveated with infection or antibiotics

normal is under 200 mg/dl
80-120 should be enco
uraged-keep steady instead of rollercoastering

Question 19

HbA1c

Answer 19

average blood glucose over 2-3 months
normal is 4-6.1%
less than 8% needed for wound healing

Question 20

walking cam boot

Answer 20

allows pt to bear some of the weight through their leg instead of through the foot

Question 21

Diabetic foot care

Answer 21

inspect daily
wash and dry feet
moisturize except b/w toes
shoe inspection to find rocks
buy proper shoes (and in the afternoon)
no foot soaks, heat, or ice