Diabetic Ulcers- Quiz 3 Flashcards
Why does type 2 DM continue to increase?
- Rising rate of obesity
- Aging population
Foot ulcers precede _____ in ____% of cases?
LE amputations, 85
Why do LE amputations happen after foot ulcers?
Having one ulcer increases your chance of getting another ulcer. It is harder to manage multiple ulcers… leading to LE amputation.
What percent are non-traumatic cause of LE amputation?
50-75%
What are secondary mechanisms that can cause Neuropathic/neurotropic ulcers? (5)
- Peripheral Vascular Disease
- Peripheral Neuropathy
- Minor Trauma
- Structural Deformity
- Infection
What is the most common type of neuropathic/ neurotrophic ulcer?
Diabetic
What are other diagnoses that can cause neuropathic/ neurotrophic ulcers? (5)
- Spina bifida
- neurologic disorders
- muscular degenerative diseases
- alcoholism
- tertiary syphilis
Why does multi-factorial ulcerations increase risk for amputation? (4 reasons)
- Previous ulcers place pts at higher risk for future ulcers
- scar tissue builds up
- skin becomes less elastic
- cause of initial ulcer may still be an issue
What are the risk factors for diabetic ulcerations? (7)
- Atherosclerosis
- decreased sensation
- foot shape (structural deformities)
- muscle contractures
- skin changes (autonomic NS and mechanical )
- immune system impacted
- Hx of previous ulcers
what is a major risk factor for LE amputation?
-PAD (peripheral arterial disease)
Why does PAD lead to amputation?
Because it decreases bl flow to LE which causes inadequate oxygenation and tissue perfusion which ultimately impairs wound healing.
What is PAD similar to?
atherosclerotic disease (CAD), artery walls thicken and become more rigid
What two proteins is insulin essential for synthesis for?
collagen and fibroblastic
What can decreased insulin cause and why?
- skin stiffness and Decreased tensile strength of tissue
- because have diminished collagen synthesis
Why is skin elasticity and increased tensile strength of tissue so important?
If you have a decrease in both (skin and tensile strength) you increase likelihood of ulcers and decrease your chance of healing
Who is peripheral neuropathy common in?
diabetic pts
What does peripheral neuropathy impact?
sensation and strength in LE
what areas of sensation are more likely to be injured with peripheral neuropathy?(4)
- Light touch
- temperature
- pain sensation
- proprioception
Skin with diminished sensation is subject to injury from ______, _______, ________ and ________.
trauma, shearing forces, excessive pressure and warm temperature burns
What causes structural deformities?
peripheral motor neuropathy (inability to feel your foot…duah)
T/F Equinus contracture is when your stronger dorsiflexions overcome your weaker plantar flexors
FALSE, it is when your stronger PF overcome weaker DF
What DF ROM do you normally see with Equinus contracture
Less than 0 deg DF
Do you have stronger inversion or eversion with Equinus contracture?
stronger eversion
With Equinus contracture what does it result in?
Increased pressure on metatarsal and toes
With Equinus contracture do you have pronation or supination?
you have both
What is hammer toe?
flexion PIP, extension DIP
what is claw toe?
flexion PIP and neutral/slight flexed DIP, bearing weight on tip of toe
What is curly toe?
flexion of PIP and DIP, literally curled under foot, bearing weight on nail
What is mallet toe?
neutral PIP and flexed DIP
Changes in foot/ankle can lead to? (3)
- altered weight distribution
- increased pressure in areas not ready for that type of load
- areas of ischemia
Why does a callus form?
response to pressure overtime
callus gets_____ and more resistant to _____ over time?
thicker, motion
What can happen with a thick, hard, immobile callus?
turns into an area of increased pressure and can develop into an ulcer
What is charcot deformity
progressive degenerative foot deformity on weight bearing joint
Charcot deformity affects ___% of DM with neuropathy
10
what are 2 theories that Charcot deformity occurs?
- increase blood and pooling in feet
- correlated with decreased bone density in pts with charcot
What 3 stages does charcot progress in?
- development
- coalescence
- reconstruction
what are the 6 characteristic of the development stage of charcot deformity?
- joint effusions
- edema
- subluxation
- formation of bone and cartilage debris
- intra-articular fractures
- bone fragmentation
how is development stage of charcot deformity initiated? and how is it aggravated?
minor trauma like walking too long, persistent ambulation
What is the coalescence stage marked by for charcot deformity? (3)
- reduction in edema
- absorption of fine debris
- healing fractures
What happens in the reconstruction stage for charcot deformity? (3)
- further repair and remodeling of bones
- fusion and rounding of large bone fragments
- decreased joint mobility
what 3 things are crucial for preventing chariot deformity?
early detection, diagnosis, and offloading
you are __x more likely to develop ulcers once the bones in the foot begin to change (charcot)? why?
4, deformities are prone to increased pressure
What is present in a majority of diabetics where ulcers have formed?
autonomic changes
what does the autonomic system do
regulates skin perspiration and bl flow to the microvasculature
What does a decrease in autonomic system result in? (4 things)
- dry skin
- cracked skin
- callus formation
- frequent toenail infections
Altered cross-linkage between ____ and _____ results in predisposed to hyperkeratosis and callus formation
collagen and keratin
why does the body have decreased immunity with DM?
- poor bl flow
- edematous tissues
What is the most common scale used for grading DFU?
Wagner grading system
T/F once an ulcer is a grade 3 it CAN become a grade 2
FALSE, it stays at grade 3 but is referred to as healing grade 3
T/F Wagner grading can distinguish ulcers with/without ischemia or tissue infection
FALSE, it cannot distinguish
What is the range of grades for Wagner?
grade 0-5
Wagner Grade 0
no ulcer but may possess pre-ulcerated lesion; healed ulcer; presence of bony deformity
Wagner Grade 1
Superficial Diabetic ulcer not involving subcutaneous tissue
Wagner Grade 2
Ulcer extends through dermis
- involves ligament, tendon, joint capsule, fascia, or bone
- no abscess or osteomyelitis
Wagner Grade 3
Deep ulcer with abscess or osteomyelitis
Wagner Grade 4
localized gangrene of foot
Wagner Grade 5
extensive gangrene of foot
what is gangrene
localized death and decomposition of body tissue rusting from either obstructed circulation or bacterial infection
what is osteomyelitis
inflammation of bone or bone marrow, usually due to infection
Which grading system gives stage and grades for ulcers?
university of Texas diabetic wound classification
Which grading system acknowledges ischemia and infection
university of Texas diabetic wound classification (UTDWC)
how many stages are there for university of texas diabetic wound classification ?
A-D
how many grades are there for university of texas diabetic wound classification ?
0-3
Texas Stage A
no infection or ischemia
Texas Stage B
infection present
Texas Stage C
Ischemia present
Texas Stage D
Infection and ischemia present
Texas Grade 0
pre or post ulcerative lesion and or completely epithelialized wound
Texas Grade 1
Superficial wound
Texas Grade 2
wound penetrates to tendon or capsule
Texas Grade 3
wound penetrates to bone or joint
What is a wound that is categorized as D3 (Texas)?
Infection and ischemia present and wound penetrates to bone or joint
