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PTRS 746 Musculoskeletal > Neuropathic Foot > Flashcards

Neuropathic Foot Flashcards

1
Q

What is the MOST COMMON cause of neuropathic foot?

A

Diabetes

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2
Q

What are the common causes of foot neuropathy? (6)

A
  • Diabetes**
  • Cancer, trauma
  • Autoimmune diseases
  • Vitamin B, E and niacin deficiency
  • Exposure to toxins
  • Infection
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3
Q

What are the 4 types of neuropathy?

A
  • Peripheral
  • Autonomic
  • Proximal
  • Focal
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4
Q

What is peripheral neuropathy?

A
  • Affects the upper and lower extremities
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5
Q

What is autonomic neuropathy?

A
  • Neuropathy causes issues with the ANS
  • Cardiopulmonary, temperature regulation, bowel, bladder and sexual systems can all be affected
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6
Q

What is proximal neuropathy?

A
  • Affects the thigh, hip, and core muscles
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7
Q

What is focal neuropathy?

A
  • There is sudden loss of function in one nerve or a group of nerves only
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8
Q

How often should a foot examination be performed?

A
  • At least once/year (annually)
  • If pt. has neuropathy it should be looked at every medical visit
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9
Q

How often should a diabetic check their feet?

A

DAILY!!!

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10
Q

What should you be looking for during a foot exam?

A
  • Cuts, blisters, signs of infection (redness, pus, etc.)
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11
Q

What are the goals of a foot exam?

A
  • Establish pt’s history and diagnostic factors
  • Identify the pt’s risk
  • Type of intervention to use
  • Pt’s education needs
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12
Q

What should you look for during the subjective exam that would indicate risk of neuropathic foot? (6)

A
  • Diagnosis (Diabetes, HIV, etc)
  • PMH
  • Complications (neuropathy, retinopathy, vascular disease)
  • History of ulcers, LE surgery, or amputation
  • Smokes, smoked in the past
  • HbA1c for diabetics
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13
Q

What do you assess during the objective exam for neuropathic foot? (5)

A
  • Condition of skin, hair, nails
  • Any deformities
  • Pulses
  • Sensation
  • Patient’s footwear
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14
Q

What skin signs would cause reason for concern?

A
  • Skin is thin, brawny, shiny, or frail
  • Dry skin
  • Calluses or wounds
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15
Q

What issues with the hair on the feet would cause concern?

A
  • Absence of hair (hair will not grow if blood flow is lacking)
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16
Q

What toenail signs would cause concern?

A
  • Thick, deformed, or ingrown nails
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17
Q

What kinds of foot deformities can be associated with neuropathic foot? (4)

A
  • Hammer/claw toes
  • Hallux valgus (AKA bunions)
  • Charcot foot
  • Prominent metatarsal heads
18
Q

What are claw toes?

A
  • Characterized by hyperextension of MTP joint with PIP/DIP flexion
19
Q

What are hammer toes?

A
  • Characterized by hyperextension of MTP and DIP joints
20
Q

What is a common cause of hallux valgus?

A
  • High heeled shoes
21
Q

What is charcot foot?

A
  • Progressive bone destruction and ligament damage
  • Results in arch collapse and compromised skin integrity
22
Q

How is charcot foot treated?

A
  • Complete immobilization in a cast, WBing restrictions
23
Q

T/F: Charcot foot is caused by neurovascular issues?

A

False: could be cause by neuro-vascular or neuro-traumatic problems or both Cause is not completely understood

24
Q

What is the Ankle Brachial Index (ABI)?

A
  • Test to determine if patient as arterial insufficiency (lack of blood flow, especially to extremities)
25
Q

How do you calculate ABI?

A

Ankle systolic BP/Brachial systolic BP

26
Q

What are the scores of ABI and what do they mean? (4)

A
  • >1.2: vessels are imcompressible
  • 1.0-1.2: Normal
  • 0.90-0.99: Acceptable
  • <0.90 Arterial disease
  • 0.50-0.80: Intermittent claudications
  • <0.50: Severe arterial disease
27
Q

What 2 tests are used to assess sensation?

A
  • Semmes Weinstein Monofilament
  • Vibratory Sensation
28
Q

How is the monofilament test assessed?

A
  • Nylon wire is used to cause 10g of pressure on 10 sensory points on the foot
  • If patients cannot detect 10g of pressure in the sensory points it indicates they have reduced sensation
29
Q

How is the vibratory test assessed?

A
  • A 128 MHz tuning fork is used to create vibration in the foot
  • If vibration is not sensed by the patient within 10 seconds loss of sensation is indicated
30
Q

What criteria would categorize a patient as LOW RISK for neuropathic foot? (3)

A
  • Patient has sensation
  • No deformities present
  • Patient has intact circulation
31
Q

What interventions would you use with a low risk patient? (3)

A
  • Proper footwear
  • Patient education
  • Yearly foot exam
32
Q

What criteria would categorize a patient as HIGH RISK for neuropathic foot? (5)

A
  • Patient has loss of sensation
  • Deformities present
  • Vascular disease
  • Callus formation
  • History of ulcers or amputation
33
Q

What interventions would you use with a high risk patient? (3)

A
  • Comprehensive exam
  • Patient education
  • Diabetic footwear
34
Q

What is involved in patient education for neuropathic foot? (4)

A
  • General diabetic self-care
  • Foot/skin care
  • Daily skin checks
  • Proper foot wear (breathable, good support, wide toe box)
35
Q

What do ulcer interventions focus on? (4)

A
  • Reduce (debulk) calluses
  • Control moisture
  • Decrease risk of skin infection (silver or antibiotic products)
  • Edema management
36
Q

What do pressure interventions focus on?

A
  • Offloading high pressure areas
37
Q

How can pressure offloading be achieved? (6)

A
  • Total contact casts
  • Orthotics
  • Walking boots
  • Surgical shoes
  • Dressings (foam or felt)
  • Cutouts in shoes to reduce pressure points - Assistive devices
38
Q

If a patient is in bed at home or in the hospital how would you position them to prevent high pressure areas?

A
  • Elevate heels with a pillow under calves
39
Q

How should neuropathic foot patients manage foot care at home? (7)

A
  • Always wear shoes
  • Check feet daily
  • Do not apply lotion between toes
  • Have nails professionally clipped
  • Reduce calluses with emery boards
  • Use Vick’s vapor rub/tea tree oil for oncyomycosis
  • Report any changes ASAP
40
Q

What other areas, besides foot care, should neuropathic foot patients work on at home? (4)

A
  • Exercise 30+ minutes/day
  • Nutrition
  • Glycemic control
  • Work with podiatrists, wound care or other medical teams if necessary
41
Q

What qualifications does a patient have to meet in order for Medicare to pay for diabetic shoes? (7)

A
  1. Patient MUST have diagnosis of diabetes and at least one other listed condition below.
  2. History of foot amputation
  3. History of foot ulcerations
  4. History of pre-ulcerative foot callus
  5. Peripheral neuropathy with evidence of callus formation
  6. Foot deformity
  7. Poor circulation
42
Q

T/F: History of diabetes and ulcerative foot calluses would qualify a patient for diabetic shoes paid for by Medicare.

A

True

PTRS 746 Musculoskeletal (9 decks)

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