neuropathic ulcer Flashcards by Owen Honroth

difference in poly and peripheral neuropathy

peripheral - hands and feet
poly - multiple limbs

How well did you know this?

Not at all

Perfectly

what % of individuals with diabetes get neuropathic ulcerations

How well did you know this?

Not at all

Perfectly

A1c levels of significance

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

How well did you know this?

Not at all

Perfectly

contraindications of blood glucose values and PT

200 mg/dL

How well did you know this?

Not at all

Perfectly

which type of diabetes is the most prevalent

How well did you know this?

Not at all

Perfectly

what is the hypothesis behind why hyperglycemia causes tissue damage

hemodynamic changes that increase microvascular pressure

glycosylation

accumulation of sorbitol

How well did you know this?

Not at all

Perfectly

what is glycosylation

hyperglycemia causing glucose to bind to proteins passively

How well did you know this?

Not at all

Perfectly

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

25 years on average

How well did you know this?

Not at all

Perfectly

sequelae of neuropathy losses

sensation
motor
autonomic

How well did you know this?

Not at all

Perfectly

what causes neuropathy

microcirculation inadequacies that lead to neural tissue ischemia and segmental demyelination

How well did you know this?

Not at all

Perfectly

in those with neuropathy, what ulceration is most common

plantar ulceration
3.5x more

How well did you know this?

Not at all

Perfectly

sensory neuropathy most affects one’s

protective sensations
- cannot detect irritation or trauma

How well did you know this?

Not at all

Perfectly

motor neuropathy most affects one’s

intrinsic foot muscles
atrophy leading to hallux valgus and claw toe

How well did you know this?

Not at all

Perfectly

foot deformities cause

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

How well did you know this?

Not at all

Perfectly

sequelae of autonomic neuropathy
locally and systemically

local disturbances in
sweating mechanism
callus formation
blood flow

systemically:
resting tachycardia
exercise intolerance
orthostatic hypotension
gastroparesis

How well did you know this?

Not at all

Perfectly

explain how mechanical stress leads to NU and delayed healing

abnormal forces predispose individuals to ulceration

overload of pressure impairs tissue ability to repair

How well did you know this?

Not at all

Perfectly

hyperglycemia’s affect on wound healing

decreased collagen synthesis, angiogenesis and fibroblast proliferation

How well did you know this?

Not at all

Perfectly

tests that should be used in those with neuropathic ulcers

doppler ultrasound
ABI
capillary refill
sensory integrity

How well did you know this?

Not at all

Perfectly

indications for ABI testing

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

How well did you know this?

Not at all

Perfectly

indications for capillary refill testing

digital ulcer
abnormal ABI

How well did you know this?

Not at all

Perfectly

indications for sensory integrity testing

neuropathic ulcer
diabetes
plantar foot ulcer
neuro injury

How well did you know this?

Not at all

Perfectly

ABI cut off for referral in NU assessment

<0.8

How well did you know this?

Not at all

Perfectly

specifics of semmes weinstein monofilaments

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

how to test sensation using tuning fork

128 Hz fork on first metatarsal head or malleolus

inability to perceive ___ monofilament indicates ____

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

plantar locations for monofilament testing

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

wagner classification grade

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

most common positions of NU

plantar forefoot first/second metatarsal heads plantar heel

foot deformities and associated locations of ulceration

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

inappropriate footwear may cause an NU at

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

wound presentation of NU

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

what grade of wagner classification indicates amputation

what education do we need to provide patients with NU

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

when is total contact casting indicated

wagner score of 1/2

role of total contact casting

molded to foot and leg to allow for proper weight distribution controls edema protects from trauma/microorganisms

contraindications of total contact casting

osteomyelitis gangrene fluctuating edema active infection ABI <0.5

therapeutic exercises for those with NU

assess great toe extension talocrural dorsiflexion strengthening invertors and hip ER aerobic exercise

what is diabetes categorized as a disease

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

main difference between type 1 and type 2 DM

1 - genetic, autoimmune disease, in ability to produce insulin 2 - develops over life, resistance to insulin

significant fasting blood glucose

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

explain the relationship between peripheral artery disease and neuropathic ulcers

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

what is diabetic neuropathic osetoarthropathy? what does it cause?

inflammatory phase characterized by foot edema, erythema, and increased temperature bone and articular destruction - progresses to multi-joint dislocation and fx

how to treat diabetic neuropathic osteoarthropathy

strict immobilization and limited weight bearing

what causes tissue failure

tissue breakdown rate exceeds tissue repair rate

how is the visual system affected by diabetes

retinopathy glaucoma cataracts

compare healing rates of forefoot ulcers and rearfoot ulcers

forefoot heal faster than rearfoot

what does A1c measure tell

average blood sugar for last 3 months

what does fasting blood sugar level tell

current blood sugar level

extent of the wound for each wagner classification

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

explain how pain will be presented in NU

absent/ significantly decreased

explain the temperature of a NU

normal or even increased

what periwound/structural changes will be observed in a NU

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

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

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

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

total contact = most AFO = middle walking shoe = least

explain medical glycemic control between DM1 and DM2

1 = insulin therapy 2 = hypoglycemic agents

medical management of pain/paresthesia includes

anticonvulsants antidepressants capsaicin