L4 Part 2: The High-Risk Foot Flashcards
Objectives aka Test Questions!!!
- Describe high risk foot including etiology, pathogenesis, and potential adverse consequences
- Describe the role of PT in the mgmt of high-risk foot
- Describe the pathogenesis of neuropathy related to the foot***
- Describe the clinical presentation of the most common diseases associated with the high-risk foot, including peripheral neuropathy, PVD, DM***
- ID impairs in sensory, motor, autonomic, vascular, and integumentary systems associated with neuropathy and the high-risk foot
- List PT examination measures for ID’d impairments in above-listed systems for the high-risk foot
- ID goals of orthotic intervention for high-risk foot
What should you ALWAYS REMEMBER TO DO W/ PATIENTS?
*ESP IF DOING LE + BALANCE EXAM???
SHOES AND SOCKS OFF!!!!!!!!!
2 Most commonly linked diseases to foot wounds:
- PVD
- Peripheral neuropathy
High risk foot is challenging to mng bc involves multiple body system impairments:
Name 5
- Sensory
- Motor
- Autonomic
- Circulatory
- MSK
Mechanical Stress
Pressure==
Pressure== Force/Area
Mechanical Stress
Pressure is a problem!!
What happens to skin and tissue when pressure applied?
Depends on three things:
Duration, Force or amt of load, Size of area being loaded
*skin breakdown
Most common culprit of breakdown in neuropathic feet==>
WALKING!!!
*repeated bouts of moderate pressure during everyday walk
*NOTE: ALWAYS make them take off shoes/socks!!!
WHY does skin of neuropathic foot break down (and NOT heal)?
Multiple system breakdown
No blood flow, O2
Neuropathic Foot
Specifically related to Diabetic Neuropathy
Key components:
-
Distal symmetric polyneuropathy***
- multiple components→ affects multiple body systems
- Sensory, motor, autonomic
- multiple components→ affects multiple body systems
-
Screen circulatory system to R/O or R/I**
- ex. check pulses
Sensory Deficits in Neuropathy
“I didn’t know anything was wrong until I saw blood on my sock.”
Complaints @ rest/with activity
- PT Exam Testing
- Incd vibratory perception thresholds
-
Loss of protective sensation
- Monofilament testing
Motor Deficits in Neuropathy
- Mm weakness
-
Mm imbalances→ foot deformities
- high plantar pressures
- → breakdown/ulceration on areas of high load or incd WB
Autonomic Dysfunction in Neuropathy
- Skin dry, less pliable, prone to fissures
- Dilation of arterioles=> hyperemia of soft tissue/bone=> Charcot’s arthropathy
Autonomic Dysfunction in Neuropathy
Prone to fissures— what is this?
Crack in dermis that cause partial-thickness wound
*entry-point for bacteria!!!
Clinical Signs of PVD
KNOW ALL!!!!
- Absent pulses, cold feet, shiny skin, intermittent claudication, loss of hair on leg/foot
- Atrophy of subcut. fat, rest pain relieved w/ dependency, delayed cap refill, ischemic lesions
MSK Deficits in Neuropathy
Name 3 categories then further explain
- High plantar pressures
- Limtd joint mobility
- Foot deformity
Soft-Tissue characteristics of High-risk foot
- Loss of fat pad
- Edema
- Changes→ color, temp, texture skin
- Open wounds***
