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Wound Care > Neuropathic Wounds > Flashcards

Neuropathic Wounds Flashcards

1
Q

What are the classifications of diabetes?

A

Type 1

Type 2

Gestational (during pregnancy)

Secondary (genetic defects, infections, diseases of exocrine pancreas, drug-induced, etc.)

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2
Q

Which classification of diabetes is most common?

A

Type 2 (85-90%)

secondary to history, lack of exercise, obesity, ethnic background, age, history of gestational diabetes, etc

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3
Q

Neuropathic is termed a “Tri-neuropathy,” what does this mean?

A

Sensory

Motor

Autonomic

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4
Q

What does the SENSORY portion of the tri-neuropathy consist of?

A

Diminished sensation

leading to

Lack of protective sensation

(Caused by damage to small nerve cells)

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5
Q

What does the MOTOR portion of the tr-neuropathy consist of?

A

Muscle weakness

leading to

Changes in foot shape

leading to

High peak pressures during WB activities

(Caused by damage to large nerve fibers)

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6
Q

What does the AUTONOMIC portion of the tri-neuropathy consist of?

A

Decreases sweat and oil production

leads to

Dry inelastic skin

(Caused by damage to large nerve fibers and sympathetic ganglion)

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7
Q

What is the impact of neuropathy on gait?

A

Shorter stride length

Longer duration of time in the stance phase

Slower gait speed

Wider BOS during gait

Greater step variability

Elevated plantar pressures

Reduced ankle ROM (DF (need 10 deg) and 1st MTP extension)

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8
Q

What are MSK changes you might see with neuropathic wounds?

A

Ankle Equinus

Bunion

Pes Cavus

Hammer toes/Claw toes

Charcot foot

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9
Q

What is ankle equinus?

A

< 90 degrees of ankle DF

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10
Q

What is the significance of having pes cavus?

A

Abnormal pressure points placed on the foot

Poor dispersion of force–possible wound formation

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11
Q

What is a charcot foot?

A

Flat foot with a “rocker” bottom

Joint subluxation causes midfoot arch to fall

http://www.bonetalks.com/footcharcot/

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12
Q

What is the road to neuropathic wounds?

A

Neuropathy

  • Sensory
  • Motor
  • Autonomic

leading to

Foot deformity

  • Loss of fat pad
  • Callus formation

leading to

Diabetic foot ulcer
- Due to mechanical trauma

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13
Q

What are the characteristics of Neuropathic ulcers?

A

LOCATION:
Weight-bearing surface of foot or dorsal digits of toes

TISSUE:
Callus or blister, slough, may probe to bone, neurotic with PAD
Red but not granulated
Periwound callus

PAIN:
NONE! Until infected, then deep throb

SKIN:
Dry, thick, scaly, hyperkeratonic

EXUDATE:
Varies, depending on infection (serosanguinous?)

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14
Q

What are the stages of neuropathic ulcer development?

A

Callus formation

Subcutaneous hemorrhage

Breakdown of skin

Deep foot infection with osteomyelitis

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15
Q

What are the causes of diabetic wounds?

A

Friction

Shear

Pressure

Poorly fitted shoes
(ALL ARE ENHANCED IN PRESENCE OF SEEMINGLY BENIGN FOOT DEFORMITIES)

Charcot deformity

Traumatic injury

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16
Q

Forces on the foot

A

Vertical

Anteroposterior shear

Mediolateral shear

17
Q

What are common causes of trauma?

A

Walking barefoot (NEVER)

Burns

18
Q

What is the PT tx for neuropathic wounds?

A

PATIENT EDUCATION

  • Blood glucose
  • Properly fitting shoes
  • Nail and callus care
  • Skin care
  • Diabetic or molded shoes if foot deformities are severe

IMPROVING ROM AND GAIT MECHANICS

OFF-LOADING

STANDARD WOUND CARE TECHNIQUES

19
Q

What is Normoglycemia?

A

Fasting < 100 mg/dL

20
Q

What is impaired fasting glucose?

A

100-125 mg/dL

21
Q

What is causation for dx of diabetes?

A

> 125 mg/dL

22
Q

When does wound healing cease to continue with diabetes?

A

> 200 mg/dL

23
Q

What is the HbA1C score and what is the goal number for a diabetic?

A

Measures average plasma glucose concentration

GOLD STANDARD FOR GLUCOSE CONTROL

Want 6.5 for diabetics

24
Q

What is the rationale for using footwear for off-loading?

A

To remove pressure completely from the site of a plantar wound or to distribute pressure over a greater surface area

25
Q

What is the gold standard for a patient with a diabetic foot ulcer, and what is it used for?

A

Total contact cast (TCC)

Optimized pressure redistribution along entire leg and plantar surface of the foot

Increases adherence

Contraindications

  • PAD, ABI < 0.7
  • Infection

Usually changed after 1-2 days at first

Then weekly until shoe can be worn

26
Q

What are some alternatives to TCCs?

A

Wound healing shoe

Accomodative dressing

Post-op shoe with plastazote inserts

CAM walker boot

PWB or NWB with AD

WC ambulation only

27
Q

What are Plastazote inserts?

A

Soft, conforming material used to make shoe inserts

Allows for greater distribution of pressure across plantar surface

28
Q

What is the management for a post-healing foot?

A

Medicare therapeutic foot bill

  • Patients with DM can get a pair of shoes each year from medicare if they have a documented impairment
  • Pays for diabetic shoes and inserts
  • Patient must have DM, previous amputation, ulceration, pre-ulcerative calluses, foot deformities, or poor circulation
  • Must be under care of physician who is managing DM

Wound Care (12 decks)

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