Test 3: Pathologies of the foot and ankle Flashcards
what is diabetes
chronic systemic disorder characterized by hyperglycemia and abnormal metabolism
primary types of diabetes
type I: auto immune; affects pancreas insulin production/secretion
type II: excessive dietary sugar and other simple carbs lead to lack of insulin; possible auto immune influences; cant process sugar due to damage of body
what is insulin/ its function
released from pancreas
lowers blood sugar
stores fat
how many americans are pre diabetic/diabetic
1/3 have pre diabetes
1/10 americans have diabetes
incidence/prevalence of diabetes
most common endocrine/metabolic disorder
type II more common (90%)
increasing obesity/sedentary lifestyle
happening in younger and younger individuals
risk factors for diabetes
family hx
obese
older age
physical inactivity
previous gestational diabetes
other conditions with insulin resistance
hx vascular disease
hypertension
low HDL cholesterol (good)
smoking
contributors to diabetes
SAD; high sugars/carbs
over 2 hrs screen time/day
daily carbonated beverages
fast food >2x/wk
unmanaged stress/lack of regular sleep (inhibits insulin production and increased cortisol that produces more sugars)
pathogenesis of type I diabetes
inability to produce and secrete adequate insulin to use glucise
pathogenesis of type II diabetes
inadequate response of insulin receptors to insulin
explain the cycle of diabetes and fat storage
sugars cause insulin production
fat is stored and systemic inflammation occurs
eventually effect of insulin is limited so body makes more
when more is made, more fat is stored and more inflammation
eventually insulin production stops bc pancreas cells are exhausted
obesity and diabetes develop
S&S of diabetes
frequent urination (polyuria)
dry mouth
extreme thirst (polydipsia)
decreased skin turgor
blurry vision due to sugar damaging blood vessels
weak/fatigued
excess hunger (body cant use insulin)
what are the 3 types of neuropathies diabetes can lead to
sensory
motor weakness of mm innervated by peripheral nn
autonomic
what is sensory neuropathy
non segmental paraesthesia and hyposensitivity or numbness if involved peripheral n
joint destruction bc repeated microtrauma isn’t felt (charcot foot)
less aware of a heart attack they are already more prone to
what is motor neuropathy
weakness of mm innervated by the involved peripheral n
what is an autonomic neuropathy
affects multiple systems, particularly cardiovascular
diminished pulses
necrosis
poor healing
stroke
cardiac dz
what are possible severe complications to diabetes
leading cause of kidney disease and blindness
cognitive dysfunction leading to alzheimers referred to as type III diabetes
what S&S of diabates can you observe in the clinic
charcot foot
dry mouth
cognitive decline
fruity and long/deep breaths with type I
what scan/BM exam fininds might you find with someone who has diabetes
ARJC S&S in 1/2 diabetics
possible weakness
diminished sensation (assess 2pt discrimination)
+ dural mobility
myotomes WNL
diminished pulses
referral for diabetes
urgent referral to MD
what are the implications for PT with pts with diabetes
higher prevalence of
-carpal tunnel
-Dupuytren’s contracture
-trigger finger
-adhesive capsulitis
-HIGHEST prevalence of DISH
delayed healing
disorganized/excessive scar tissue
nociplastic pain
why may osteoporosis develop in those with diabetes
due to increased osteoclastic activity
usually develops in first 5 years
explain what it means that exercise with diabetes is a “balancing act”
check in with MD initially
no restrictions if glucose is managed well
3-10 bouts of CV activity better for sugar levels than 1 30 min session (exercise is good for lowering blood sugar)
wait 1-2 hours after a meal (eating lowers blood sugar, so if you eat and exercise and both lower sugar you could then become hypoglycemic)
may need to decrease insulin prior to exercise (same thing, dont want to drop sugar too low)
may need extra carbs to build glucose stores
keep snacks handy
signs of hypoglycemia
HA
dizzy
low energy
tachycardia
shaky
difficulty focusing
signs of hyperglycemia
thirst
N&V
dehydration S&S
dulled senses
weak pulse
abdominal pain
education for diabetic pts (dressing/obs/avoid)
wear accomodating shoes and socks
examine feet regularly for skin breakdown
avoid alcohol and cortisone shots (high sugars in both)
systemic inflammation is a primary contributor to what conditions
diabetes
HTN
high triglycerides
low HDL
being overweight
> 2/5 = metabolic syndrome
what is gout
metabolic disorder with elevated levels or uric acid and deposition of urate crystals
incidence/prevalence of gout
1st MTP is most common site
most common crystallopathy in the US
primarily in middle aged males
risk factors for gout
family hx
decreased renal functioning
conditions that increase uric acid production
conditions that limit excretion of uric acid
high fructose from SAD
high nitrogen in organ meats, trout, shellfish, and sardines
what are examples of conditions that increase uric acid production
leukemia
lymphoma
psoriasis
RBC disorder
conditions that limit uric acid excretion
alcoholism
HTN
obesity
renal and thyroid disorders
etiology of uric acid
genetic is primary
secondary to another disorder
idiopathic or unknown
pathogenesis of gout
uric acid typically forms from breaking down cellular waste in blood
kindeys are unable to process higher amounts of uric acid
more uric acid remains in circulaiton and migrates primarily to joints
sparks inflammatory response leading to tissue change
what tissue changes may take place with gout
necrosis of original tissue
proliferation of fibrous secondary tissue
S&S of gout
symptoms develop 10-20 years after hyperuricemia
typically monoarticular (one joint)
rather sudden onset of severe joint pain
episodic with increasing frequency/severity
may develop cellulitis
may have constitutional S&S if multiple joints involved
PT implications of gout
edu pt on risk factors
pts often develop subsequent orthopedic conditions in and around gout area
clinical S&S that could indicate gout for PT
Hx
observation of redness/swelling
warm temp
scan/BE similar to ARJC findings but sudden
referral for gout
urgent
what is osteomyelitis
inflammation of a bone due to microorganism
destructive infection
incidence/prevalence of osteomyeltitis
uncommon in wealthier cultures
resurgence with longevity and IV drug use
most common in tarsal and metatarsal bones (43%) followed by tibia and femur
also can occur in vertebra
risk factors for osteomyelitis
immunosupression
chronic illness like diabetes
IV drug use
joint replacement
etiology and pathogenesis of osteomyelitis
complex and poorly understood
microorganisms typically staphlococcus aureus
preferential to cartilage
metaphysis of bone is very porous so it spreads quickly
clinical manifestations of osteomyelitis
gradual onset of deep and achy pain and stiffness = most common presenting symptom
infection S&S
localized and progressive pain that limits motion and WBing
may develop constitutional S&S
what S&S might you see in a PT clinic for osteomyelitis in the foot
Hx
asymmetrical gait
red/hot/swollen
scan/BE like ARJC
referral for osteomyelitis
urgent referral to MD
