Insensate Foot Flashcards
Neuropathic ulcers AKA
diabetic ulcer
Neuropathic ulcer develops in ___% of diabetic patients
30%
More then 50% will require amputation
Insensitive foot causes
DM is most common Alcoholism Hanson's disease (leprosy) Neurological diseases (MS) Arterial insufficiency SLE Vit B deficiency Uremia
Tri-neuropathy
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
Risk factors for ulcer development
Sensory loss Motor loss Autonomic neuropathy Vascular disease Impaired healing response Foot deformities Poor or no foot wear Limited joint mobility
Risk factors for ulcer development - Sensory loss
Protective sensation (10 grams pressure, 5.07 monofilament)
Vibratory sensation - and prop (128 Hz)
Impaired hot/cold sensation
Standards of medical care in diabetes - American diabetes association
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
Risk factors for ulcer development - Motor loss
Intrinsic mm atrophy causes foot deformities (claw toes)
Inc plantar pressures and changes pressure points
Excessive pronation with instability
Risk factors for ulcer development - Autonomic
Dry inelastic skin
Hyperperfuction
Inc Ca absoprtion from bone
Risk factors for ulcer development - Vascular disease
Atheroscleorsis
Basement membrane thickening within arterial system
Limited involvement in development of ulcer but significant in healing
Risk factors for ulcer development - Footwear
Serves to control function and protective function too
Risk factors for ulcer development - Limited joint mobility
Increased mechanical stresses
Additional deformities
Risk classification system
0 = no loss of productive sensation 1 = loss of protective sensation 2 = loss of protective sensation and deformity present 3 = history of plantar ulcer
Neuropathy disability score in pts with diabetes - evaluates what
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
Neuropathy disability score in pts with diabetes - interpreting results
A score of more than 6 (for both feet) is predictive of a foot ulceration
Neuropathic ulcers - characteristics Location Shape Exudate Skin Pain Pulse
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
Charcot Foot - describe it
Degenerative arthropathy Neuropathic fracture Related to a loss of autonomic regulation Osteolysis Foot becomes hot, swollen Fractures and demineralization
Wagner neuropathic ulcer classification
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
University of Texas Wound classification - classified by
graded by depth
AND a stage within the grade
University of Texas Wound classification - grade
0 = Epithelialized wound 1 = Superficial wound 2 = Wound penetrates to tendon or capsule 3 = Wound penetrates to bone of joint
University of Texas Wound classification - stage
A = No infection or ischemia B = Infection present C = Ischemia present D = Infection and ischemia present
Infections
Typically not the cause of ulcers but often occur with the ulcers
Osteomyelitis is a common problem
BONE = INFECTION until proven otherwise
Neuropathic ulcers - general tx guidelines
Control glucose levels Off loading procedures Foot care Proper shoe wear Mobility activities Aerobic exercise with focus on control of hyperglycemia Infection risk management
