Neuropathic Foot

Question 1

Defn of Neuropathic Foot

Answer 1

nerve damage to the feet that can present in loss of sensation (n/t) OR as painful neuropathy (burning, sharp, aching pain)

Question 2

Etiologies/Risk Factors for Neuropathic Foot

Answer 2

1. DIABETES
   - 50% are affected
   - leading cause of diabetic hospitalization
   - 50-75% of non-traumatic amputations
2. tumor, trauma, other conditions
3. autoimmune disease (RA, GBS, SLE)
4. Vitamin B, E or niacin deficiency
5. exposure to toxins (chemo, heavy metals)
6. Infection (HIV, lymes disease, shingles)

Question 3

When should a comprehensive foot assessment be completed?

Answer 3

At least annually –> more often if complications exist

If they have neuropathy –> each medical visit
If they have diabetes –> each day at home

Question 4

What to look for in an objective assessment?

Answer 4

1. Condition of skin, hair & toenails
2. Deformities
3. Pulses & ABI
4. Sensation
5. Shoe wear

Question 5

Condition of skin, hair and toenails - OBJ assessment

Answer 5

Skin - is it thin? shiny? brawny or frail? dry? calluses/wounds?
–> specifically look at areas of wear

Hair - is it present or absent?
–> if no hair then probably weakened or no pulse

Toenails - thickened, deformed, ingrown

Question 6

Foot Deformities (5)

Answer 6

Will normally see multiple deformities on one foot

1. Prominent MT heads
   - causes calluses under MTP & on top of IP
2. Hammer toe
   - hyperextension of DIP
3. Claw toe
   - flexion of DIP
4. Hallus Valgus (bunions)
   - brace or fixed surgically w/ pins
5. Charcot foot
   - progressive bone destruction & ligament damage –> complete arch collapse & impaired skin integrity
   - complete immobilization & total contact cast

Question 7

Pulses & ABI - OBJ exam

Answer 7

1. Posterior tib
2. Dorsal pedis

ABI - ankle brachial index - ratio of LE systolic BP to UE systolic BP (how well circulation is reaching the lower limb)
>1.2 = vessels are incompressible
1-1.2 = normal
.9-.99 = acceptable

Question 8

Sensation (2) - OBJ exam

Answer 8

1. Semmes Weinstein Monofilament
   - 10g monofilament
   - test at 10-12 sites on bottom of foot (1 on top)
2. Vibratory Sensation
   - 128Hz tuning fork
   - latency of 10 seconds = sensory loss

Question 9

Assessment of Neuropathic foot

-Low risk vs. High risk

Answer 9

Low risk = preserved sensation, no deformity, intact circulation

High Risk = sensory loss, deformity, vascular disease, callus formation, history of ulcer, amputation

Question 10

Plan of Care for Pt. w/ Neuropathy

Answer 10

EDUCATION IS KEY!

• diabetes self care
• foot & skin care, daily checks
  
  • dont apply lotion btwn toes, clip nails, manage calluses, immediately report changes
• proper, breathable footwear

Exercise >30min/day - aerobic & resistance

Nutrition - monitor BMI, encourage wt. loss, check glucose levels (HbA1c debulk, control moisture, decrease infection risk & manage edema

Offloading w/ casts, cutouts, ass. devices, & make sure to elevate heels w/ pillow under calves when in bed