Insensate Foot

Question 1

Neuropathic ulcers AKA

Answer 1

diabetic ulcer

Question 2

Neuropathic ulcer develops in ___% of diabetic patients

Answer 2

30%

More then 50% will require amputation

Question 3

Insensitive foot causes

Answer 3

DM is most common
Alcoholism
Hanson's disease (leprosy)
Neurological diseases (MS)
Arterial insufficiency
SLE
Vit B deficiency 
Uremia

Question 4

Tri-neuropathy

Answer 4

Sensory - loss of sensation
Motor - loss of intrinsic mm function - leads to foot deformities
Autonomic - loss of sweat and oil production - also changes blood flow patterns

Question 5

Risk factors for ulcer development

Answer 5

Sensory loss
Motor loss
Autonomic neuropathy
Vascular disease
Impaired healing response 
Foot deformities
Poor or no foot wear
Limited joint mobility

Question 6

Risk factors for ulcer development - Sensory loss

Answer 6

Protective sensation (10 grams pressure, 5.07 monofilament)
Vibratory sensation - and prop (128 Hz)
Impaired hot/cold sensation

Question 7

Standards of medical care in diabetes - American diabetes association

Answer 7

Pt with diabetes should be screened annually for DPM tests using pinprick sensation, temp, and vibration perception, and monofilament pressure sensation, and ankle reflexes
Combo of more than one test inc sensitivity

Question 8

Risk factors for ulcer development - Motor loss

Answer 8

Intrinsic mm atrophy causes foot deformities (claw toes)
Inc plantar pressures and changes pressure points
Excessive pronation with instability

Question 9

Risk factors for ulcer development - Autonomic

Answer 9

Dry inelastic skin
Hyperperfuction
Inc Ca absoprtion from bone

Question 10

Risk factors for ulcer development - Vascular disease

Answer 10

Atheroscleorsis
Basement membrane thickening within arterial system
Limited involvement in development of ulcer but significant in healing

Question 11

Risk factors for ulcer development - Footwear

Answer 11

Serves to control function and protective function too

Question 12

Risk factors for ulcer development - Limited joint mobility

Answer 12

Increased mechanical stresses

Additional deformities

Question 13

Risk classification system

Answer 13

0 = no loss of productive sensation
1 = loss of protective sensation
2 = loss of protective sensation and deformity present
3 = history of plantar ulcer

Question 14

Neuropathy disability score in pts with diabetes - evaluates what

Answer 14

Vibration (normal = 0, abnormal = 1)
Temperature (normal = 0, abnormal = 1)
Pinprick (normal = 0, abnormal = 1)
Achilles reflex (present = 0, present with reinforcement = 1, absent = 2)
Total for one foot = 0-5 points

Question 15

Neuropathy disability score in pts with diabetes - interpreting results

Answer 15

A score of more than 6 (for both feet) is predictive of a foot ulceration

Question 16

Neuropathic ulcers - characteristics
Location
Shape
Exudate
Skin
Pain
Pulse

Answer 16

Located in pressure areas of the limb - often plantar foot surface
May be found under or rimmed by calluses
Regular shaped wound edges
Mild to no exudate
Skin dry and flaky
Little to no pain
Pulses are normal and bounding

Question 17

Charcot Foot - describe it

Answer 17

Degenerative arthropathy 
Neuropathic fracture 
Related to a loss of autonomic regulation 
Osteolysis 
Foot becomes hot, swollen
Fractures and demineralization

Question 18

Wagner neuropathic ulcer classification

Answer 18

0 = Pre ulcerative lesions, healed ulcers, presence of bony deformity 
1 = Superficial ulcer without subcutaneous tissue involvement
2 = Penetration through the subQ tissue; may expose bone, tendon, ligament or joint capsule
3 = Osteitis, abscess or osteomyelitis
4 = Gangrene of digit
5 = Gangrene of foot requiring disarticulation

Question 19

University of Texas Wound classification - classified by

Answer 19

graded by depth

AND a stage within the grade

Question 20

University of Texas Wound classification - grade

Answer 20

0 = Epithelialized wound
1 = Superficial wound
2 = Wound penetrates to tendon or capsule
3 = Wound penetrates to bone of joint

Question 21

University of Texas Wound classification - stage

Answer 21

A = No infection or ischemia
B = Infection present 
C = Ischemia present
D = Infection and ischemia present

Question 22

Infections

Answer 22

Typically not the cause of ulcers but often occur with the ulcers
Osteomyelitis is a common problem
BONE = INFECTION until proven otherwise

Question 23

Neuropathic ulcers - general tx guidelines

Answer 23

Control glucose levels
Off loading procedures 
Foot care
Proper shoe wear
Mobility activities 
Aerobic exercise with focus on control of hyperglycemia
Infection risk management