Lecture 2

Question 1

What is intermittent claudication?

Answer 1

Pain in the legs, esp. the posterior aspect and calves due to vascular insufficiency. These pains occur during prolonged walking, and it is alleviated w/ rest.

Question 2

What is arteriosclerosis obliterans?

Answer 2

A marked decrease or absence of pulse in at least ONE of the major LE arteries (femoral, popliteal, posterior tibialis, dorsalis pedis).

Question 3

How are pulses measured (what is the grading system?)

Answer 3

0 = absent
1+ = Faint
2+ = Slightly diminished
3+ = Normal
4+ = Bounding

Question 4

True or False: You should measure pulses with your thumb.

Answer 4

FALSE! NEVER measure pulses w/ your own thumb because the radial artery traverses through the palmar aspect of the thumb.

Question 5

What is the ABI and what does it measure?

Answer 5

The Ankle Brachial Index is a good measure of PAD.

Question 6

How does one measure ABI?

Answer 6

Take the BP of the brachial arteries on each side. Take the BP of the posterior tibialis artery and the dorsalis pedis artery. Whichever of the two LE BPs is higher, use this number for the equation. LE BP/UE BP =ABI. We want a the number to be at or around 1.

Question 7

What are the values for ABI?

Answer 7

Above 1.2 =Abnormal vessel hardening
1.0-1.2 = Normal
.90-.99 = Acceptable
.80-.89 = Some arterial dz
.50-.79 = Moderate arterial dz
Under .50 = SEVERE arterial dz

Question 8

What is a large predisposing factor for a LE amputation?

Answer 8

Peripheral neuropathy.

Question 9

In terms of a peripheral neuropathy, what is lost?

Answer 9

Loss of sense of pain, thermal changes, and protective senses. THE PATIENT DOES NOT HAVE TO LOSE ALL THREE!!! CAN HAVE PERIPHERAL NEUROPATHY AND ONLY HAVE LOST ONE!!

Question 10

A peripheral neuropathy is suspected when a patient presents w/ 1 or more of the following clinical signs:

Answer 10

1. Sensation deficit (Achilles/patellar DTR, vibratory sense, protective sense)
2. Motor deficit (loss of intrinsic foot mm control)
3. Autonomic deficit (absence of sweating)

Question 11

Pressure on soft tissue is related to what three aspects?

Answer 11

1. Pressure over area
2. Surface area pressure is on
3. Length of time pressure is sustained

All based on the idea that Pressure = Force/Area

Question 12

What is a TCC?

Answer 12

A Total Contact Cast is a cast that can be used for when a patient w/ DM has an ulcer. This type of cast covers all areas of the foot EXCEPT for the area w/ the ulcer. It aims to reduct pressure on that area of the foot. It is on a rocker bottom system so the pt can still ambulate safely, and it limits DF to decrease pressure over the dorsal aspect of the forefoot.

Question 13

What are the functional levels of a patient who has a LE amputation?

Answer 13

K0: Cannot safely ambulate w/o AD.
K1: Uses prosthesis for transfers and can only ambulate at a fixed speed.
K2: Limited community ambulator. Can walk at two different speeds.
K3: Community ambulator. Can walk at different speeds and on different terrains.
K4: Exceeds basic ambulation (Olympics)

Question 14

What is the most difficult aspect of the gait cycle for those w/ partial foot prostheses?

Answer 14

Terminal stance of gait cycle.

Question 15

What was the first ES foot prosthesis?

Answer 15

The first ES (energy storing) prosthesis is the Seattle Foot.

Question 16

What is the Wagner Classification for Diabetic Ulcers?

Answer 16

Grade 0: No ulceration in a high risk foot
Grade 1: Superficial ulceration
Grade 2: Deep ulceration through tissues (tendon, bone, or joint)
Grade 3: Deep abscess (osteomyelitis)
Grade 4: Deep abscess (localized gangrene)
Grade 5: Deep abscess (widespread gangrene)

Question 17

What is a SACH foot? Is it NAR/AR, NES/ES?

Answer 17

Solid Ankle Cushion Heel is a prosthetic device that is part of the foot/ankle component. It is Non Articulating and Non-Energy Storing