Foot Flashcards
What are the things that tend to cause a bounding pulse?
Fever Aortic insufficiency Complete heart block Thyrotoxicosis Systolic HTN
(FACTS)
What is the landmark of the DP pulse?
Extensor hallucis tendon
What is the landmark of the PT pulse?
Medial side, midway between the malleolus and calcaneus tendon
Which part of the popliteal fossa is the artery found? How can this be improved?
Medial side
Flex the knee
What does the capillary fill time do?
Determines the state of tone of the cutaneous microcirculation
Where should you evaluate the capillary refill time in the feet?
Tip of the toenail
Decreased capillary refill may suggest what?
Vasospasm or structural changes to the large vessels
Is pitting edema an acute event?
No, but non pitting is
How do you assess for pitting?
Press for 5 seconds. Should return to normal in under 5 seconds. If not, then pitting
What are the possible causes of pitting edema?
Systemic disease CHF
What causes non-pitting edema?
Lack of protein in exudate (liver and kidney problems)
1+ edema measurement is how deep?
2mm
2+ edema measurement is how deep?
4mm
3+ edema measurement is how deep?
6mm
4+ edema measurement is how deep?
8mm
Are macules palpable? How big are they?
no
<0.5cm
Are patches palpable? How big are they?
no
> 0.5 cm
Are papules palpable? How big are they?
Yes
<0.5 cm
Are nodules palpable? How big are they?
Yes
0.5 cm - 1 cm
Are tumors palpable? How big are they?
yes
>1 cm
Are plaques palpable? How big are they?
Yes
> 0.5 cm
What are vesicles? Size? Characteristics?
Size = <0.5 cm
clear fluid filled
Palpable
What are bullas? Size? Characteristics?
Clear, fluid flilled
palpable
>0.5 cm
What are abscesses? Size? Characteristics?
Cloudy, pus filled palpable lesions, >0.5 cm
What are pustules? Size? Characteristics?
Cloudy, pus filled, <0.5 cm in size. Palpable
What are secondary lesions?
Lesions that are the result of progressive changes in the primary lesions or are caused by external causes
What are abscesses on the toe?
Paronychia
What are onychomycosis? Can you look at it and diagnose it?
Thickened nails d/t fungal infections
Need culture
What are the causes of thickened nails?
Trauma Onychmycosis Eczema Circulatory problems Lichen planus Yellow nail syndrome Psoriasis Tumor
(TOE CLYPT)
What are the four causes of dry skin on the foot?
- Insufficient sweat glands
- Tinea pedis
- psoriasis
- eczema
What is an ulcer?
Loss of the epidermis
If the base of the ulcer is red, then what is the prognosis?
Good b/c there is good blood supply to the area
What is the scale for muscle strength? What are normal values?
0-5
5 is normal
You see the tendon contract, but there is no movement of the joint. Grade this muscular movement?
1/5
The patient is able to move foot or leg into the desired position when horizontal to exam table. Rate this MS.
2/5
The patient is able to perform movement with leg hanging over the side of the table or sitting. Grade this MS.
3/5
There is a slight decrease from normal strength. Rate this MS.
4/5
What is a corn?
Thickened stratum corneum in an area d/t pressure
What are the 3 systems evaluated in a neuro exam?
Motor
Sensory
ANS
What are the two pathways that sensation travel through?
- Posterior column
2. Lateral spinothalamic tract
Which tract are burning or cramping pain felt in?
Spinothalamic tract
Which tract are pins and needles or electric shock pain felt in?
Posterior column
What are the small fibers of the neurosensory tract?
Spinothalamic tract
What are the large fibers of the neurosensory tract?
Posterior column
Abnormality of the touch stimuli test indicated what?
Small fiber disease
What is the tool that you use for the touch stimuli?
Semmes-weinstein monofilament
When do you do the temp test?
Iff there is abnormal pain sensation
Lack of temperature sensation suggests what?
Small fiber disease
Abnormal vibration test indicates what? What is the tool used?
Large fiber disease
128 cycle tuning fork
How long should the tuning fork be felt in the foot?
30 seconds but for sure more than 10
How do you accurately grab the great toe for a proprioception test? An abnormal test is indicative of what?
on the sides, move up and down
Abnormal = large fiber disease
True or false: an absent Achilles reflex after 80 yo is normal
True
What is the scale of tendon reflexes?
0-4
What are the knee reflexes innervated by?
L2, L3, L4
What are the ankle reflexes innervated by?
S1, S2
What is the innervation of the superficial reflex or plantar response?
L4, L5, S1, S2
How do you elicit a superficial reflex? What is the normal result?
Stroking the lateral aspect of the sole from the heel to the ball of the foot
Toes should plantarflex
What is the all-in-one test for the feet? What does this indicate?
hop on one foot
Indicates:
- intact motor system of the legs
- Normal cerebellar
- good position sense
If a pt is able to stand on tiptoes, but not on the heels, what does this suggest?
Peripheral neuropathy
If a pt is able to stand on heels, but not on tiptoes, what does this suggest?
Spinal lesions
With normal vagal nerve input to the heart, the pulse at rest will (BLANK) with increase, and (BLANK) with expiration
Inspire - increase
Expiration = decrease
What is the Babinski response? What does this indicate?
A result of the plantar reflex response, where there is dorsiflexion of the great toe and fanning of the other toes
This indicates upper motor neuron disease
What type of fibers compose the posterior column? Spinothalamic? (slow/fast)
Posterior column = Fast
Spinothalamic = Slow
What type pain is experienced via the posterior column? Spinothalamic? (burning/cramp or electric)
PC = Electric shocks Spinothalamic = burning
What nervous tract is able to sense temperature? (spinothalamic or posterior column)
Spinothalamic
