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Assistive Tech > P - Neuropathic Foot > Flashcards

P - Neuropathic Foot Flashcards

1
Q

what are 2 major risk factors for neuropathic ulcer

A

loss of protective sensation
mechanical stress

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2
Q

what pathology is neuropathic ulceration the most common thing you will see in that patient population

A

DM

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3
Q

what does neuropathic ulceration result from in DM

A

poor glucose control

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4
Q

what are 2 characteristics of peripheral vascular dz that increase the risk of neuropathic ulceration

A

tissue breakdown
delayed wound healing

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5
Q

what is the sequence that leads to lower extremity amputation

A

minor injury
ulceration
faulty ulcer healing
infection
spreading
amputation

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6
Q

how does loss of protective sensation become a significant risk factor for neuropathic ulcers

A
  1. limited awareness of foot injury d/t dec sensation
  2. fail to initiate injury avoidance behaviors
  3. delay seeking medical treatment –> don’t realize there is a problem until it is significant
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7
Q

how is protective sensation tested

A

semmes-weinstein nylon 5.07 filament (10g of bending force)

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8
Q

what does the classification for risk of plantar ulcer and amp in neuropathic foot test

A

for loss of protective sensation

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9
Q

what are the category classifications for determining the risk of plantar ulceration and amp in the neuropathic foot

A

Category 0 - normal
- lo loss of protective sensation

Category 1 - loss of protective sensation (5.07 filament) at any areas of foot tested

Category 2 - loss of protective sensation and evidence of high presssure
- callus, deformity, joint limitation

Category 3 - hx of plantar ulceration

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10
Q

what are examples of evidence of high pressure that you might see in a category 2 (risk of plantar ulcer and amp)

A

callus

deformity
- bunion
- hammer toe
- claw toe

joint limitation
- lack of DF, midfoot motion, great toe ext
-> changes the mechanics of wt bearing and walking

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11
Q

what are types of mechanical factors (4)

A

pressure
shear
intrinsic
extrinsic

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12
Q

pressure vs shear mechanical factors

A

pressure = compressive
- vertical
- fairly easy to measure
- can measure barefoot or in shoe

shear = horizontal forces
- harder to measure

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13
Q

intrinsic vs extrinsic mechanical factors

A

intrinsic = bone or joint deformity

extrinsic = environment around foot (ie shoe)

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14
Q

what are intrinsic factors that are associated w high foot pressure

A

bone deformity
joint limitation

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15
Q

what are examples of bone deformities as an intrinsic mechanical factor (6)

A

bunion
claw toe
rearfoot varus/valgus
forefoot varus/valgus
charcot foot
partial amp

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16
Q

what is often the underlying component for a bone deformity

A

intrinsic ms weakness (small plantar intrinsics)

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17
Q

how does a bony deformity like a claw toe inc risk for ulceration

A

intrinsic ms weakness
MT heads become more prominent –> curl down and get more load and pressure on head –> MT head not designed to take load –> toe ulceration

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18
Q

what is a common location for ulcers associated with claw toe

A

toe ulcers

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19
Q

what determines the degree of ulceration in rearfoot and forefoot varus/valgus deformities

A

degree of compensation
- amt of ROM determines amt of compensation possible and thus determines amt of load

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20
Q

what risk factor for ulceration are rearfoot and forefoot varus/valgus deformities associated with

A

abnormal foot pressures

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21
Q

what is a charcot foot

A

collapse of tarsal bones leading to midfoot ulceration
- radiographic changes at talonavicular &/or calcaneal cuboid joints

22
Q

what is type of path is charcot foot considered

A

neuropathic osteoarthropathies

23
Q

where is ulceration expected in charcot foot

A

midfoot

24
Q

where is ulceration expected in forefoot varus (compensated)

A

1st or 5th MT head

25
Q

where is ulceration expected in forefoot varus (uncompensated) and why

A

5th MT head

rigid varus/inverted position, WBing stays in same lateral part of foot

26
Q

what will active ortho pts w uncompensated forefoot varus present as often to PT

A

stress fx at 5th MT head
- not meant to bear weight on the lateral side of our foot

27
Q

where is ulceration expected in forefoot valgus and why

A

1st MT head

valgus/everted position, medial side of forefoot, plantar side of big toe hitting ground early in gait

28
Q

how is a partial amputation an intrinsic factor for ulceration

A

results in greater loading force on residual limb

29
Q

how is great toe amputation an intrinsic factor for ulceration and why

A

inc pressure on remaining 1st ray segment
- in gait heel strike, then pronate to push thru great toe

transfer lesion
- load shifts to 2nd MT -> not meant to take load

30
Q

what limitations in motion can be intrinsic factors for ulceration

A

1st MTP ext
PF 1st ray
ankle DF

31
Q

where is there increased stress with limited 1st MTP extension

A

IP joint during propulsion
-> toe ulceration

32
Q

what role does 1st MTP extension play in gait

A

need 65deg or >

as move thru end of stance phase and heel comes off ground –> get DF there
- if don’t have that motion get load there and at toes earlier in gait cycle (propoulsion) or in later stance phase

33
Q

where is there increased stress with rigid PF 1st ray

A

on 1st MT head

34
Q

where is there increased stress with limited ankle DF (ankle equinus)

A

forefoot & risk of ulceration there

35
Q

in general ortho pop, what problems will you see with limited ankle DF and why

A

when DF stops, heel comes up early and force on forefoot earlier in gait cycle and there for longer duration than meant to be
-> metatarsalgia
-> plantar surface foot pain

36
Q

what are reasons for limited ankle DF

A

restricted talocrural joint
restricted GS complex

37
Q

motor neuropathy in peroneal n. distribution vs tibial n. distribution: common pt pop, ROM limitations, areas of inc stress

A

peroneal = forefoot
- common in DM
- foot equinus, hallux limitus
high forefoot stress

tibial = rear foot
- common in SCI
- limited PF
high stress at heel

38
Q

what are 3 levels of stress that can cause injury

A

momentary high
repetitive mod
cont low

39
Q

what is the most common MOI to an insensate foot

A

repetitive mod stress from walking

40
Q

what is the response to repetitive mod stress from walking in normal vs loss of protective sensation

A

normal - alter behavior
- stop activity, shift WBing stress to another area

no protective - cont activity
- in same manner until # of reps exceeds a tolerable stress threshold resulting in skin breakdown

41
Q

what are 2 integumentary concerns if person is at risk for ulceration

A

noncompliant dry skin
hyperkeratosis (callus)

42
Q

why is noncompliant dry skin an integumentary concern

A

breeding grounds for infection
-> cracking & ulceration

43
Q

what causes hyperkeratosis (callus)

A

response to tissue stress

44
Q

why is hyperkeratosis (callus) an integumentary concern

A

inc pressure –> injury
can mask underlying ulceration

removal of heavy callus shown to dec foot pressure

45
Q

what are causes of tissue atrophy

A

ms or connective tissue atrophy
fat pad migration from bony areas

46
Q

what can impact a person’s ability to self inspect feet

A

obesity
vision loss
joint limitation

(common in elderly)

47
Q

what are 3 other factors impacting the risk for ulceration

A

inability to self inspect feet
high impact exercise
skin temperature

48
Q

how can high impact exercise impact risk for ulceration and what is recommended in pts w DM

A

abnormal stress levels

low impact exercise
- stationary bike
- swimming, UE exercies

49
Q

what is an elevated skin temperature predictive of

A

ulceration and charcot fx in pts w DM

50
Q

what can elevated skin temp be d/t

A

inflammation
- soft tissue stress
- infection or bony injury

51
Q

what skin temperature change is significant

A

should be symmetric b/w limbs
- significant if >1-2deg C

52
Q

what are 4 steps to foot screening

A

test for sensory loss
identify signs of skin lesions
assess ROM and strength
inspect footwear

Assistive Tech (17 decks)

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