neuropathic ulcers

Question 1

caused by

Answer 1

Often caused by lack of sensation so often no wound related pain (however may have neuropathic pain in the area)

Question 2

how do neuropathic ulcers look

Answer 2

Round, punched out lesion rimmed in callous; light drainage; light pink wound bed, may have some necrotic tissue
*friable
*can be completely covered by callous

Question 3

if ulcer has callous,

Answer 3

usually neuropathic ulcer

Question 4

neuropathic ulcer periwound looks like

Answer 4

Key to this type of wound is the callous that build up due to pressure
Toenails may be thickened due to fungal infection
May have edema if they have autonomic neuropathy (causes vasodilation)
Pulses may be present but microvascular changes are common
May be warm if there is vasodilation but may be cool if there is microvascular changes

Question 5

risk factors for type II DM

Answer 5

> 85%body weight for age and sex
120% ideal weight
Having close relative with DM
Being a high-risk ethnic origin
Having a mother with history of gestational DM

Question 6

neuropathic ulcer: autonomic neuropathy

Answer 6

***callus formation, and blood flow
Decreased sweating

Systemic effects: tachycardia, exercise intolerance, hypotension, gastroparesis, & sexual dysfunction

Question 7

osteoarthropathy

Answer 7

Uncontrolled vasodilation caused increased blood flow to bone->leeches Calcium-> predisposes for fracture=>charcot foot

Question 8

what happens to rate of collagen synthesis, phagocytosis, angiogenesis and fibroblast proliferation and tensile strength
with neuropathic ulcers?

Answer 8

decreased rate of everything due to hyperglycemia

Question 9

What is a normal A1C

Answer 9

less than 5.7%

Question 10

What is prediabetes A1C

Answer 10

5.7-6.4%

Question 11

what is diabetes A1C

Answer 11

over 6.4%

Question 12

ways of assessment of circulation

Answer 12

Capillary refill, doppler US, ABI, TBI, arteriography or transcutaneous O2 measurement

Question 13

how to perform semmes weinstein test

Answer 13

Use Semmes-Weinstein monofilament to test for protective sensation 5.07 (10 g); test at 1st, 3rd, and 5th digits, 1st, 3rd, and 5th met heads, medial and lateral midfoot and calcaneus; apply enough pressure to bend the wire and test each area 3 times

Question 14

how should you perform local wound care?

Answer 14

-callus must be removed
wound edge made even with base if possible
-moisturize periwound
-protect wound with offloading devices
*EDUCATE!!!!

Question 15

what is the gold standard of care for neuropathic ulcers?

Answer 15

total contact cast TCC

Question 16

when should you not use a total contact cast?

Answer 16

patient may not be compliant to come back
-infection
-edema fluctuations
-ABI less than 0.45

Question 17

what else should PTs tell patients with neuropathic ulcers?

Answer 17

gait and mobility for offloading!!!
ROM: manual therapy at foot/ankle
aerobic: helps with glycemic control

Question 18

Good glycemic control can reduce the development and progression of the long term complications of DM-1% decrease in A1c can lead to ____decrease in microvascular complications and _____reduction in amputations

Answer 18

1% decrease of A1C
25% decrease in microvascular complications
36% reduction in amputations