Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Integumentary > Neuropathic Ulcers > Flashcards

Neuropathic Ulcers Flashcards

1
Q

What are neuropathic ulcers caused by?

A

Repeated stress on feet that have diminished sensation

Neuropathy is a common factor in almost all of these wounds.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the most common cause of neuropathic ulcers? what are some other causes

A

Diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

List some primary neurological conditions that can cause neuropathic ulcers.

A
  • Spina bifida
  • HIV/AIDS
  • Multiple sclerosis
  • Alcoholic neuropathy
  • Herniated discs or spinal abnormalities
  • Exposure to toxins
  • Vitamin B deficiency
  • Renal failure
  • Trauma
  • Surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What percentage of patients with diabetes face the risk of foot ulcers?

A
  • 15% - 20%

80-85% of amputations are preceded by a foot ulcer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the mortality rate after amputation in diabetes patients?

A

50% in 3-5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the two main types of diabetes? describe each

A
  • Type 1 (IDDM): often presents in childhood, related to pancreatic islet cells and production of insulin
  • Type II (NIDDM): body develops a resistance to effects of insulin (most over 40) 90% of them are overweight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does hyperglycemia do to wound healing?

A

Slows the wound healing response

  • accelerates atherosclerotic process
  • impairs fucntion of neurophils, macrophages, and fibroblasts (proliferation)
  • decreased function of cytokines, growth factors
  • macro/microvascular impairments
  • higher risk of infection becuase of delays in cellular function
  • long term = nerve damage to distal nerve fiber
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is glycosylation in the context of diabetes?

A
  • Long-term hyperglycemia leads to glucose binding with proteins to form advanced glycation end products (AGEs)
  • This facilitates the formation of irreversible cross-links with collagen = stiffening Connective tissue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Vascular effects of DM

A
  • leading risk factor for CAD, CVD, and PVD
  • accelerates rate of atherosclerosis
  • causes thickening of basment membrane resulting in decreased delivery of oxygen and nutrients
  • less likely to have revascularization if ciruclation problems occur
  • patients with DM more likely to have amputation
  • smoking can accelerate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the key risk factors for neuropathic ulcers?

A
  • Pressure
  • Hyperglycemia
  • Vascular disease
  • Neuropathy
  • Mechanical stress
  • Abnormal foot function
  • Impaired immune response
  • Poor vision
  • Inadequate education
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Peripheral neuropathy: onset and typical progression

-

A
  • gradual onset: painless, or gradual increase in numbness, tingling, burning or pins/needles (dont realize they have neuropathy)
  • sudden onset: usually initially painful, then sudden disappearance leaving sensory loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the characteristics of neuropathic ulcers?

A
  • Absent or significantly reduced pain
  • position: plantar aspect of foot
  • Round, punched-out lesions
  • Dry, cracked peri-wound area
  • Normal pulses
  • Normal or increased temperature
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the appearance of dry gangrene? cause?

A
  • Dry, black, and shriveled tissue
  • no odor
  • no discharge
  • line of demarcation
  • skin above may be health
  • caused by lack of nutrition

It is caused by lack of nutrition and has no odor or discharge.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the appearance of wet gangrene?

A
  • Painful, purple, swollen tissue
  • infected
  • malodorous/purulent drainage
  • demarcation is ill defined
  • caused by excessive moisture

It is caused by excessive moisture and is often infected.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the gold standard for assessing sensory integrity in diabetic patients?

A

Semmes-Weinstein monofilaments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What types of interventions are important for managing diabetic foot ulcers?

A
  • Education
  • Non-invasive skin and nail care
  • Local wound care
  • Orthotics and adaptive equipment
  • Off-loading techniques
17
Q

What are some foot care guidelines for diabetic patients?

A
  • Inspect feet daily
  • Always wear socks (inside out if they have seams)
  • Do not walk barefoot
  • Wash feet daily and dry well
  • Maintain good diabetes control
  • shoes should fit properly
  • do not soak feet
  • test water temps
  • trim nails straight across
  • regular goot exams
  • physician removes corns and calluses report wounds or foot changes immediately
  • maintain good disabetes control
18
Q

What is Total Contact Casting (TCC) used for? and how does it assist with healing

A

To improve weight bearing over the entire lower leg for grade 1 and 2 neuropathic ulcers

  • allows WB forces to be distributed over larger area
  • rigid cast helps with edema and improve local circulation
  • immobilized foot and reduces shearing forces
  • protects foot from trauma and microogranisms
  • increases patient adherene to care becuase it allows activity

It helps distribute weight-bearing forces over a larger area.

19
Q

What are the contraindications for Total Contact Casting?

A
  • Presence of gangrene
  • Osteomyelitis
  • Fluctuating edema
  • Active infection
  • Inability to care for cast
  • ABI < 0.45
20
Q

What should physical therapists educate patients about regarding diabetes management?

A

Awareness of blood sugars and the impact of physical activity

21
Q

What type of exercise is recommended for diabetic patients to lower hyperglycemia?

A

Minimum of 150 minutes of moderate-intensity aerobic activity per week

Examples include walking, cycling, and swimming.

22
Q

Polyneuropathy: sensory

A
  • unable to sense pain and pressure
  • 50% of patients unaware of protective sensation loss
  • unable to perceive 5.07 monofilament = risk of ulceration/loss of protective sensation
23
Q

poly neuropathy: motor neuropathy:

A
  • loss of intrinsic muscularture, resulting in clawed toes and eventually foot drop
  • may lose ankle reflex
  • atrophy predisposes to plantar pressure and shear forces
  • cause foot to be less stable in gait
24
Q

polyneuropathy: autonomic

A
  • disturbances in sweat and oil production (callus formation), blood flow
  • leads to dry, less elastic, cracked skin
  • increased risk of osteopenia and foot fracture
25
Q

neuropathic ulcers

exam findings

A
  • Neuromusclar: clawed toes, rigid, insensate foot
  • vascular: signs of PVD
  • MSK: skeletal changes, charcot joint, gait dysfunction, toe deformities
  • integ: hypertrophic nails, hyperkeratotic lesions, dry skin with fissues (autonomic response), callous, rash, infections, signs of trauma, gangrene
26
Q

charcot foot

A
  • relatively painless, degenerative arthroplasty caused by underlying neuropathy
  • skeletal damage due to neuropathy
  • progressive OA: joint dislocation, pathologic fx, deformities
  • concavity of arch lost
  • toes lose contact with surface
  • shear forces on MT heads
  • demineralization of bones/osteopenia
  • motor denervation cause muscle imbalance
27
Q

classification of neuropathic ulcers

A
  • 0: foot at risk; thick calluses, bone deformities, clawed toes, and prominent metatarsian head
  • 1: superficial ulcers: total destruction of thickness of the skin
  • 2: deep ulcers: penetrates through skin, fat, ligaments, and not affected o=bone (infected)
  • 3: abscessed deep ulcers: limited necrosis in toes or the foot
  • 4: limited gangrene: limited necrosis in toes or the foot
  • 5: extensive gangrene: necrosis of the complete foot with systemic effects
28
Q

diabetes management program

A
  • diabetes self management education/training
  • medical nutritional therapy
  • physical activity
  • pharmacologic management
  • glucose monitoring - blood glucose/HbA1c
  • challenges: education, depression, and burnout adherence
29
Q

PT tests and measures for neuropathic ulcers

A
  • inspection
  • assessment of circulation
  • assessment of sensory integrity: monifiliments (4.17 = normal)
  • virbation, sharp/dull
  • ankle reflexes
30
Q

Wound care/medical Interventions for neuropathies/neuropathic ulcers

A
  • education
  • non-invasive skin/nail care
  • local wound care
  • orthotics and adpative equipment
  • total contact casting
  • cast shoes, dynamic splints, neuropathic walker
  • off-loading
  • medical surgical management
31
Q

What are some non-invasive skin/nail care (local wound care)

A
  • takae care of nails and cuticles
  • manage calluses and heel fissues
  • daily application of moisturizer to minimize dry, cracked skin(not between toes)
  • wound care: consistent wtih appearance (clease/debride necrotic tissue)
32
Q

What are some adjunct modalities for What are some non-invasive skin/nail care (local wound care)

A
  • ultrasound
  • negative pressure wound therapy
  • electrical stimulation
  • growth factors
33
Q

Orthotics/shoes, socks and blocks

A
  • shoes: soft leather that conforms to abnormalities and allows for depth to accommodate inserts (large toe box)
  • shank rocker bottom to facilitate motion and decrease pressure of forefoot/great toe
  • sock: no seams, cotton/acrylic blend, cushioned with non-restrictive top
  • blocks: shoe fillers for an area of ampulation
  • orthotics: to provide accommodation for foot contours; soft but semi-rigid
34
Q

medical management for neuropathic ulcers

A
  • tight glycemic control
  • management of paresthesia’s/neuropathic pain/infection
35
Q

surgical interventiosn for neuropathic ulcers

A
  • debridement
  • antimicrobial bead implanation
  • stabilization of MSK deformities/charcot deformity
  • amputations for gangrenous
36
Q

PT interventions for neuropathies/neuropathic foot ulcers

A
  • education
  • awareness of blood sugar/impact of physical activity
  • gait and mobility training
  • NWB/PWB if needed to offload pressurre
  • ROM exercises
  • aerobic exercise: lower hyperglycemia, weight loss

Integumentary (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions