Neuropathic Foot Flashcards
What is the MOST COMMON cause of neuropathic foot?
Diabetes
What are the common causes of foot neuropathy? (6)
- Diabetes**
- Cancer, trauma
- Autoimmune diseases
- Vitamin B, E and niacin deficiency
- Exposure to toxins
- Infection
What are the 4 types of neuropathy?
- Peripheral
- Autonomic
- Proximal
- Focal
What is peripheral neuropathy?
- Affects the upper and lower extremities
What is autonomic neuropathy?
- Neuropathy causes issues with the ANS
- Cardiopulmonary, temperature regulation, bowel, bladder and sexual systems can all be affected
What is proximal neuropathy?
- Affects the thigh, hip, and core muscles
What is focal neuropathy?
- There is sudden loss of function in one nerve or a group of nerves only
How often should a foot examination be performed?
- At least once/year (annually)
- If pt. has neuropathy it should be looked at every medical visit
How often should a diabetic check their feet?
DAILY!!!
What should you be looking for during a foot exam?
- Cuts, blisters, signs of infection (redness, pus, etc.)
What are the goals of a foot exam?
- Establish pt’s history and diagnostic factors
- Identify the pt’s risk
- Type of intervention to use
- Pt’s education needs
What should you look for during the subjective exam that would indicate risk of neuropathic foot? (6)
- 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
What do you assess during the objective exam for neuropathic foot? (5)
- Condition of skin, hair, nails
- Any deformities
- Pulses
- Sensation
- Patient’s footwear
What skin signs would cause reason for concern?
- Skin is thin, brawny, shiny, or frail
- Dry skin
- Calluses or wounds
What issues with the hair on the feet would cause concern?
- Absence of hair (hair will not grow if blood flow is lacking)
What toenail signs would cause concern?
- Thick, deformed, or ingrown nails
What kinds of foot deformities can be associated with neuropathic foot? (4)
- Hammer/claw toes
- Hallux valgus (AKA bunions)
- Charcot foot
- Prominent metatarsal heads
What are claw toes?
- Characterized by hyperextension of MTP joint with PIP/DIP flexion
What are hammer toes?
- Characterized by hyperextension of MTP and DIP joints
What is a common cause of hallux valgus?
- High heeled shoes
What is charcot foot?
- Progressive bone destruction and ligament damage
- Results in arch collapse and compromised skin integrity
How is charcot foot treated?
- Complete immobilization in a cast, WBing restrictions
T/F: Charcot foot is caused by neurovascular issues?
False: could be cause by neuro-vascular or neuro-traumatic problems or both Cause is not completely understood
What is the Ankle Brachial Index (ABI)?
- Test to determine if patient as arterial insufficiency (lack of blood flow, especially to extremities)
How do you calculate ABI?
Ankle systolic BP/Brachial systolic BP
What are the scores of ABI and what do they mean? (4)
- >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
What 2 tests are used to assess sensation?
- Semmes Weinstein Monofilament
- Vibratory Sensation
How is the monofilament test assessed?
- 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
How is the vibratory test assessed?
- 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
What criteria would categorize a patient as LOW RISK for neuropathic foot? (3)
- Patient has sensation
- No deformities present
- Patient has intact circulation
What interventions would you use with a low risk patient? (3)
- Proper footwear
- Patient education
- Yearly foot exam
What criteria would categorize a patient as HIGH RISK for neuropathic foot? (5)
- Patient has loss of sensation
- Deformities present
- Vascular disease
- Callus formation
- History of ulcers or amputation
What interventions would you use with a high risk patient? (3)
- Comprehensive exam
- Patient education
- Diabetic footwear
What is involved in patient education for neuropathic foot? (4)
- General diabetic self-care
- Foot/skin care
- Daily skin checks
- Proper foot wear (breathable, good support, wide toe box)
What do ulcer interventions focus on? (4)
- Reduce (debulk) calluses
- Control moisture
- Decrease risk of skin infection (silver or antibiotic products)
- Edema management
What do pressure interventions focus on?
- Offloading high pressure areas
How can pressure offloading be achieved? (6)
- Total contact casts
- Orthotics
- Walking boots
- Surgical shoes
- Dressings (foam or felt)
- Cutouts in shoes to reduce pressure points - Assistive devices
If a patient is in bed at home or in the hospital how would you position them to prevent high pressure areas?
- Elevate heels with a pillow under calves
How should neuropathic foot patients manage foot care at home? (7)
- 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
What other areas, besides foot care, should neuropathic foot patients work on at home? (4)
- Exercise 30+ minutes/day
- Nutrition
- Glycemic control
- Work with podiatrists, wound care or other medical teams if necessary
What qualifications does a patient have to meet in order for Medicare to pay for diabetic shoes? (7)
- Patient MUST have diagnosis of diabetes and at least one other listed condition below.
- History of foot amputation
- History of foot ulcerations
- History of pre-ulcerative foot callus
- Peripheral neuropathy with evidence of callus formation
- Foot deformity
- Poor circulation
T/F: History of diabetes and ulcerative foot calluses would qualify a patient for diabetic shoes paid for by Medicare.
True
