Neuropathic Ulcers Flashcards
cause of neuropathic ulcers
Lack of sensation • Abnormal muscle function -> abnormal pressure on foot structures • Autonomic dysfunction Decreased sweating – dry skin-> cracked • Skin acidity-controls ability to fight bacteria • Ischemia • ↓ Immunity- – unable to generate inflammatory phase
risk factors of neuropathic ulcers
Diabetes • Smoking • Age • Loss of sensation • SCI • Neuropathy
characteristics of neuropathic ulcers
Peripheral pulses present (unless arterial component) • Skin temp is warm • Skin color is normal • Wound on foot, metatarsal heads, between toes, WB surface Dry scaly skin • Often small at surface • Surrounding skin is dry, thin, flaking • Loss of sensation in LE or foot • Foot deformity often present • Diminished reflexes • No drainage unless infected
diagnostic test for diabetic ulcers
For sensation-
Semmes-Weinstein
Monofilaments
– ABI may also be done
what does a value of 5.07 (10-g) indicate
protective sensation
(if unable to feel- 98% of feeling is lost)
what is a normal range for semmes-weinstein monofilaments
3.63-4.0
What does a high value greater than 1.4 ABI indicate
that the vessels may be calcified in persons with DM
what areas are tested using the semmes-weinstein monofilaments
10 points on each foot: – Plantar surface of 1st, 3rd and 5th toes – Metatarsals of 1st, 3rd and 5th toes – Medial and lateral arches – Heel – Dorsum of foot
What does the score of the Semmes-Weinstein Monofilaments diagnostic test tell you
the total number of times
the monofilament was NOT perceived
what is the best score you can get on this diagnostic test
the best score is a 0
What can the Semmes-Weinstein Monofilaments diagnostic test predict
ulceration and amputation
interventions of neuropathic ulcers
Professional foot care • Well fitting foot wear • Pressure relief foot wear • Wound cleansing • Debridement • Dressings • Education
What components are part of foot inspection
– Nails- cracked, broken – Broken skin, check between toes – Callus- check for cracks – Drainage – Odor – Mirror check daily
What precautions should we educate a patient on that they should never do
They should NEVER: Walk barefoot • Use adhesive tape on feet • Soak feet • Put feet in hot water
what are the key stress variables that contribute to skin injury on plantar surface of the foot
magnitude, time and direction of stress
