Neuropathic Foot Flashcards
1
Q
What is the MOST COMMON cause of neuropathic foot?
A
Diabetes
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
3
Q
What are the 4 types of neuropathy?
A
- Peripheral
- Autonomic
- Proximal
- Focal
4
Q
What is peripheral neuropathy?
A
- Affects the upper and lower extremities
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
6
Q
What is proximal neuropathy?
A
- Affects the thigh, hip, and core muscles
7
Q
What is focal neuropathy?
A
- There is sudden loss of function in one nerve or a group of nerves only
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
9
Q
How often should a diabetic check their feet?
A
DAILY!!!
10
Q
What should you be looking for during a foot exam?
A
- Cuts, blisters, signs of infection (redness, pus, etc.)
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
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
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
14
Q
What skin signs would cause reason for concern?
A
- Skin is thin, brawny, shiny, or frail
- Dry skin
- Calluses or wounds
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)
16
Q
What toenail signs would cause concern?
A
- Thick, deformed, or ingrown nails
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
How do you calculate ABI?
Ankle systolic BP/Brachial systolic BP
26
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
27
What 2 tests are used to assess sensation?
- Semmes Weinstein Monofilament
- Vibratory Sensation
28
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
29
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
30
What criteria would categorize a patient as LOW RISK for neuropathic foot? (3)
- Patient has sensation
- No deformities present
- Patient has intact circulation
31
What interventions would you use with a low risk patient? (3)
- Proper footwear
- Patient education
- Yearly foot exam
32
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
33
What interventions would you use with a high risk patient? (3)
- Comprehensive exam
- Patient education
- Diabetic footwear
34
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)
35
What do ulcer interventions focus on? (4)
- Reduce (debulk) calluses
- Control moisture
- Decrease risk of skin infection (silver or antibiotic products)
- Edema management
36
What do pressure interventions focus on?
- Offloading high pressure areas
37
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
38
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
39
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
40
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
41
What qualifications does a patient have to meet in order for Medicare to pay for diabetic shoes? (7)
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
T/F: History of diabetes and ulcerative foot calluses would qualify a patient for diabetic shoes paid for by Medicare.
True
