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Clin Med II - FINAL > Pathologies Related to the Foot and Ankle > Flashcards

Pathologies Related to the Foot and Ankle Flashcards

1
Q

What is diabetes mellitus?

A

Chronic systemic disorder characterized by hyperglycemia and abnormal metabolism

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2
Q

What is type I diabetes?

A
  • Auto-immunity affecting the pancreas that produces insulin
  • Deficiency of insulin production and secretion
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3
Q

What is type II diabetes?

A
  • Excessive dietary sugar and other simple carbohydrates limits effect of insulin
  • May be influenced by auto-immunity
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4
Q

What is insulin?

A
  • Released from the Pancreas
  • Lowers blood sugar
  • Stores fats
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5
Q

How many americans are prediabetic?

A

1/3 of Americans are pre-diabetic; a huge number… (US pop. > 330 million)

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6
Q

How many americans have diabetes?

A

~ 1/10 Americans with diabetes

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7
Q

Diabetes is the MOST common __________/__________ disorder

A

Endocrine/metabolic

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8
Q

Is type I diabetes or type II more common?

A

type II MORE common (> 90%) than type I

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9
Q

What is happening with the population that diabetes is occuring in?

A

Occurring in younger and younger individuals
- MORE sedentary lifestyles
- Increasing obesity

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10
Q

What are type I diabetes risk factors?

A
  • family hx
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11
Q

What are type II diabetes risk factors?

A
  • family hx
  • ethnic origin
  • obesity
  • increasing age
  • habitual physical inactivity
  • previous hx of gestational diabetes or babies over 9 lbs
  • presence of other clinical conditions with insulin resistance
  • hx of vascular disease
  • previously identified impaired fasting glucose or glucose intolerance
  • hypertension
  • HDL cholesterol level
  • cigarette smoking
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12
Q

What ar other contributors to diabetes mellitus?

A
  • SAD- layered with sugars and simple carbohydrates
  • ≥ 2 hrs. of screen time/day as a part of a sedentary lifestyle
  • Daily carbonated beverage- MORE sugar
  • Fast food > 2x/wk.- MORE sugar
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13
Q

Why can unmanaged stress and lack of regular sleep cause diabetes?

A
  • Inhibits insulin production
  • Increased cortisol production that produces MORE sugars
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14
Q

What is the pathogenesis of type I diabetes?

A

inability to produce and secrete adequate insulin to use glucose

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15
Q

What is the pathogenesis of type II diabetes?

A

inadequate response of insulin receptors to insulin

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16
Q

What can inadequate response to insulin such as with type II diabetes cause?

A
  • Excessive carbohydrate (CHO)/sugar intake
  • increasing insulin production
  • increasing fat storage and SYSTEMIC INFLAMMATION
  • As the cycle continues you limit the effect of insulin, so the body makes even MORE insulin
  • MORE fat storage and SYSTEMIC INFLAMMATION
  • Insulin production finally stops or nearly stops bc Pancreatic cells that make insulin are exhausted
  • Obesity and diabetes develop
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17
Q

What are cardinal S&S with diabetes?

A
  • Frequent urination (polyuria)
  • Dry mouth
  • Extreme thirst (polydipsia)
  • Decreased skin turgor
  • Blurry vision due to sugar damaging blood vessels
  • Weakness/fatigue
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18
Q

What are the 3 types of nneuropathies that diabetes can progress to?

A

1, sensory
2. motor
3. autonomic

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19
Q

What are the qualities of senosry neuropathy with diabetes?

A
  • Large ill-defined areas of non-segmental paresthesia and hyposensitivity or numbness of involved terminal nn
  • Joint destruction because repeated microtrauma is not felt- Charcot foot- see next slide
  • Less aware of a heart attack they are already MORE prone to
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20
Q

What are qualities of a motor neuropathy with diabetes?

A

weakness of mm. innervated by the involved terminal nn.

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21
Q

What are qualities of an autonomic neuropathy with diabetes?

A
  • Diminished pulses
  • Necrosis, especially distally, i.e., wounds, amputations
  • Poor healing
  • Stroke
  • Cardiac dz
  • Excess hunger because cells can’t use glucose with ineffective insulin… so more eating… obesity
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22
Q

What are some other severe complications for all types of diabetes?

A
  • Leading cause of kidney dz and blindness
  • Cognitive dysfunction leading to Alzheimer’s, referred to as type III diabetes
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23
Q

What will we find with observation with diabetes?

A

Charcot foot
Dry mouth
Cognitive decline
Fruity and long deep breaths with type 1

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24
Q

What will we find in our scan and biomechanical exam with diabetes?

A
  • Age-related Joint Change S&S in ½ of diabetics
  • Resisted/MMT- possible weaknesses

> Neuro
- Diminished sensation
- Terminal n. pattern
- Also assess 2 pt. discrimination and monofilament sensation
- + Dural mobility tests
- Weaknesses of involved terminal nn.
- Myotomes WNL

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25
Q

What can we palpate for with diabetes?

A

diminished pulses

26
Q

What kind of referral is diabetes?

A

Urgent referral to MD

27
Q

What other PT conditions can diabetes make more likely due to the systemic inflammation and impaired circulation?

A
  • HIGHER prevalence of Carpal Tunnel Syndrome, Dupuytren’s contracture, Trigger finger, and Adhesive Capsulitis
  • HIGHEST prevalence of DISH (enthesis ossification) in those with Diabetes
  • Delayed healing
  • Disorganized and excessive scar tissue
  • Nociplastic pain
  • SYSTEMIC INFLAMMATION
28
Q

Systemic inflammation with diabetes is the primary contributor to:

A
  1. Diabetes
  2. HTN
  3. High triglycerides
  4. Low HDL
  5. Being overweight
    >2/5 = metabolic syndrome
29
Q

Why are there contraindications to grade V JMs with diabetes?

A
  • Due to increase in osteoclastic activity, Osteoporosis develops in first 5 years of dx
  • Hardening of aa and their walls associated with Diabetes
30
Q

Can type II diabetes be controlled/reversed?

A

yes, with proper diet, exercise, and/or medications

31
Q

What should we know about exercising with diabetes?

A

Check with MD initially - “balancing act”
- No restrictions if glucose levels monitored and managed well
- 3 10-minute bouts of cardiovascular activity better for sugar levels than 1 30-minute bout
- Wait to exercise 1-2 hrs. after a meal
- May need to decrease insulin prior to exercise
- May need extra carbs to build glucose “stores” after exercise
- Keep snacks handy in case of hypoglycemia

32
Q

What are S&S of hypoglycemia?

A
  • rapid onset
  • labile, irritable, nervous mood
  • difficulty concentrating. speaking, focusing
  • shake, hungry, HA, dizziness,
  • palor, sweating
  • normal mucous membrane
  • shallow respirations
  • tachycardia
  • tremor, dialated pupils, convulsions
33
Q

What are S&S of hyperglycemia?

A
  • gradual onset
  • lethargic
  • dulled sensorium, confused
  • thirst, weakness. N&V, abdominal pain
  • flushed, signs of dehydration
  • dry and crusty mucous membranes
  • deep rapid breaths
  • fruity and acetone breath odor
  • diminished reflexes, paresthesias
34
Q

What is our patient education with diabetes?

A
  • Wear accommodating shoes and socks
  • Examine feet regularly for skin breakdown
  • Avoid alcohol and cortisone shots, high sugars in both
35
Q

What is gout?

A

metabolic disorder with elevated levels of uric acid and deposition of urate crystals

36
Q

Where is gout most common?

A

1st MTP is MOST common site

37
Q

What is gout the most common disorder of in the US?

A

MOST common crystallopathy in the US

38
Q

What population is gout most common in?

A

Primarily in middle-aged biological males

39
Q

What are risk factors for gout?

A
  • Family hx
  • Decreased renal function with aging
  • Conditions increasing uric acid production, i.e., leukemia, lymphoma, psoriasis, or RBC disorder
  • Conditions limiting excretion of uric acid, i.e., alcoholism, HTN, obesity, and renal and thyroid disorders
  • High fructose of SAD
  • High nitrogen in organ meats, trout, shellfish, sardines, etc.
40
Q

What is the etiology of gout? (primary and secondary)

A

Primary- Genetic
Secondary to another disorder
Idiopathic or unknown

41
Q

What is the pathogenesis of gout?

A
  • Uric acid typically forms from breaking down cellular waste in the bloodstream
  • Kidneys unable to process higher amount of uric acid
    So MORE uric acid remains in circulation and migrates, primarily to joints
  • Sparks an inflammatory response leading to tissue changes
  • Necrosis of original tissue
  • Proliferation of fibrous secondary tissue
42
Q

What are clinical manifestations of gout?

A

*** Symptoms develop after ~ 10-20 yrs. of hyperuricemia… so it’s been going on for a while…
* Typically, monoarticular
* Rather sudden onset of severe joint pain, often at night or morning
* Episodic with increasing frequency and severity based pm risk factors
* May develop cellulitis or infection
* May have constitutional symptoms if multiple joints involved

43
Q

What can we tell out patients about gout?

A
  • Education on causes and risk factors
  • Patients often develop subsequent orthopedic conditions in and around gouty area
44
Q

What will we find in observaiton with gout?

A

Redness
Swelling

45
Q

What will we find with temperature with gout?

A

warmth, possibly fever

46
Q

What generality will we find in our scan and biomechanical exam with gout?

A

findings like age-related joint changes

47
Q

What kind of referral is gout?

A

Urgent referral to MD

48
Q

What is osteomyelitis?

A

Inflammation of bone due to microorganism
Destructive infection

49
Q

What is the incidence/prevalence of osteomyelitis?

A
  • Uncommon in wealthier countries… but resurgence with longevity and IV drug use
  • MOST common in tarsal and metatarsal bones (43%) followed by tibia and femur
  • Also, may occur in vertebra- see thoracic notes
50
Q

What are risk factors for osteomyelitis?

A
  • Immunosuppression
  • Chronic illness like Diabetes
  • IV drug use
  • Joint replacement
51
Q

What is the etiology and pathogenesis of osteomyelitis?

A
  • Complex and poorly understood
  • Microorganisms, typically Staphylococcus aureus
  • Preferentially binds to cartilage
  • Metaphysis of bone is very porous… spreads quickly
52
Q

What are clinical manifestations and S&S of osteomyelitis?

A
  • Gradual onset of deep and achy P!/stiffness is MOST common presenting symptom
  • Infection S&S
  • Localized and PROGRESSIVE P! that limits motion and WBing, may become constant
  • May develop constitutional symptoms
53
Q

What will we observe with osteomyelitis?

A

Asymmetrical gait, Red and swollen

54
Q

What will we find with temperature with osteomyelitis?

A

warmth, possibly fever

55
Q

What will we find with our scan and biomechanical exam with osteomyelitis?

A

findings like age-related joint changes

56
Q

What kind of referral is osteomyelitis?

A

Urgent referral to MD

57
Q

Where is osteochondritis dissecans MOST common?

A

MOST common in medial femoral condyle and talus

58
Q

What are clinical manifestations / S&S of osteochondritis dissecans in the foot/ankle?

A

S&S of hypermobility/instability of involved ligament but with persistent age-related joint like changes

59
Q

What will we find in our scan with osteochondritis dissecans of the foot/ankle?

A
  • ROM- limited and painful, particularly with DF
  • Resisted/MMT- may be weak and painful, particular at end range DF
  • Compression likely (+) and distraction relieving
60
Q

What will we find in our biomechanical exam with osteochondritis dissecans of the foot/ankle?

A

Stability tests (+)
TTP over talar dome

61
Q

What kind of referral is osteochondritis dissecans?

A

Urgent referral to MD

Clin Med II - FINAL (5 decks)

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