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neuropathic ulcer Flashcards

1
Q

difference in poly and peripheral neuropathy

A

peripheral - hands and feet
poly - multiple limbs

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2
Q

what % of individuals with diabetes get neuropathic ulcerations

A

25

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3
Q

A1c levels of significance

A

normal - <5.7
pre - 5.7 to 6.4
diabetes - >6.5

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4
Q

contraindications of blood glucose values and PT

A

200 mg/dL

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5
Q

which type of diabetes is the most prevalent

A

2

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6
Q

what is the hypothesis behind why hyperglycemia causes tissue damage

A

hemodynamic changes that increase microvascular pressure

glycosylation

accumulation of sorbitol

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7
Q

what is glycosylation

A

hyperglycemia causing glucose to bind to proteins passively

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8
Q

what is the timeframe for ulcer development in a patient diagnosed with diabetes

A

25 years on average

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9
Q

sequelae of neuropathy losses

A

sensation
motor
autonomic

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10
Q

what causes neuropathy

A

microcirculation inadequacies that lead to neural tissue ischemia and segmental demyelination

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11
Q

in those with neuropathy, what ulceration is most common

A

plantar ulceration
3.5x more

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12
Q

sensory neuropathy most affects one’s

A

protective sensations
- cannot detect irritation or trauma

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13
Q

motor neuropathy most affects one’s

A

intrinsic foot muscles
atrophy leading to hallux valgus and claw toe

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14
Q

foot deformities cause

A

abnormal shear forces on foot in the places not suited for them

  • collapse of foot arch leads to ulcerations in the middle of the foot rather than heel or ball of foot
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15
Q

sequelae of autonomic neuropathy
locally and systemically

A

local disturbances in
sweating mechanism
callus formation
blood flow

systemically:
resting tachycardia
exercise intolerance
orthostatic hypotension
gastroparesis

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16
Q

explain how mechanical stress leads to NU and delayed healing

A

abnormal forces predispose individuals to ulceration

overload of pressure impairs tissue ability to repair

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17
Q

hyperglycemia’s affect on wound healing

A

decreased collagen synthesis, angiogenesis and fibroblast proliferation

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18
Q

tests that should be used in those with neuropathic ulcers

A

doppler ultrasound
ABI
capillary refill
sensory integrity

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19
Q

indications for ABI testing

A

plantar foot ulceration
decreased/absent pulses
s/s of arterial insufficiency
hx of PVD
hx of CAD

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20
Q

indications for capillary refill testing

A

digital ulcer
abnormal ABI

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21
Q

indications for sensory integrity testing

A

neuropathic ulcer
diabetes
plantar foot ulcer
neuro injury

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22
Q

ABI cut off for referral in NU assessment

A

<0.8

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23
Q

specifics of semmes weinstein monofilaments

A

closed eyes during testing
5.07 monofilament
avoiding callused areas
randomly test each location 3x

24
Q

how to test sensation using tuning fork

A

128 Hz fork on first metatarsal head or malleolus

25
Q

inability to perceive ___ monofilament indicates ____

A

4.17 = decreased sensation
5.07 = loss of protective sensation
6.1 = absent sensation

26
Q

plantar locations for monofilament testing

A

pads of big toe, third and pinky
ball of foot
below third toe
below pinky toe
medial/lateral mid foot
heel pad

27
Q

wagner classification grade

A

0 - no open lesion
1 - superficial ulcer
2 - deep ulcer to tendon, bone or capsule
3 - deep ulcer with abscess, osteomyelitis, joint sepsis
4 - localized gangrene
5 - gangrene of entire foot

28
Q

most common positions of NU

A

plantar forefoot
first/second metatarsal heads
plantar heel

29
Q

foot deformities and associated locations of ulceration

A

hallux rigidus = plantar big toe
rocker-bottom = midfoot
claw toe = dorsal aspect of toes

30
Q

inappropriate footwear may cause an NU at

A

tips of toes
lateral aspect of 5th MTP
medial aspect of 1st MTP
posterior heel

31
Q

wound presentation of NU

A

round, punched out
callused rim
minimal drainage
rarely eschar/necrotic material

32
Q

what grade of wagner classification indicates amputation

A

3+

33
Q

what education do we need to provide patients with NU

A

role of exercise
risk factor reduction
daily skin checks and care guidelines

34
Q

when is total contact casting indicated

A

wagner score of 1/2

35
Q

role of total contact casting

A

molded to foot and leg to allow for proper weight distribution

controls edema

protects from trauma/microorganisms

36
Q

contraindications of total contact casting

A

osteomyelitis
gangrene
fluctuating edema
active infection
ABI <0.5

37
Q

therapeutic exercises for those with NU

A

assess great toe extension
talocrural dorsiflexion

strengthening invertors and hip ER

aerobic exercise

38
Q

what is diabetes categorized as a disease

A

disorder of carbohydrate, protein and fat metabolism due to changes in body’s ability to produce/ use insulin

39
Q

main difference between type 1 and type 2 DM

A

1 - genetic, autoimmune disease, in ability to produce insulin

2 - develops over life, resistance to insulin

40
Q

significant fasting blood glucose

A

normal = <100 mg/dL
prediabetes = 100-125 mg/dL
diabetes = >126 mg/dL

41
Q

explain the relationship between peripheral artery disease and neuropathic ulcers

A

thickened basement membrane
- decreased O2 levels
- decreased nutrient delivery to tissue

42
Q

what is diabetic neuropathic osetoarthropathy? what does it cause?

A

inflammatory phase characterized by foot edema, erythema, and increased temperature

bone and articular destruction
- progresses to multi-joint dislocation and fx

43
Q

how to treat diabetic neuropathic osteoarthropathy

A

strict immobilization and limited weight bearing

44
Q

what causes tissue failure

A

tissue breakdown rate exceeds tissue repair rate

45
Q

how is the visual system affected by diabetes

A

retinopathy
glaucoma
cataracts

46
Q

compare healing rates of forefoot ulcers and rearfoot ulcers

A

forefoot heal faster than rearfoot

47
Q

what does A1c measure tell

A

average blood sugar for last 3 months

48
Q

what does fasting blood sugar level tell

A

current blood sugar level

49
Q

extent of the wound for each wagner classification

A

0 = none, superficial, partial thick
1 = partial to full thickness
2-5 = full thickness

50
Q

explain how pain will be presented in NU

A

absent/ significantly decreased

51
Q

explain the temperature of a NU

A

normal or even increased

52
Q

what periwound/structural changes will be observed in a NU

A

dry, cracked skin with callus
fungal infection
peripheral edema
structural deformities of the foot

53
Q

what ulcer grades indicate padded AFO vs Walking shoe vs total contact cast

A

total contact = 1,2
walking = 1,2,3,4
AFO = 1,2,3,4

54
Q

explain the progression of decreased shear forces between total contact, AFO. and walking shoe

A

total contact = most
AFO = middle
walking shoe = least

55
Q

explain medical glycemic control between DM1 and DM2

A

1 = insulin therapy
2 = hypoglycemic agents

56
Q

medical management of pain/paresthesia includes

A

anticonvulsants
antidepressants
capsaicin

Integ (12 decks)

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