Test 3: Pathologies of the foot and ankle Flashcards by Braden Talbert

what is diabetes

chronic systemic disorder characterized by hyperglycemia and abnormal metabolism

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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

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what is insulin/ its function

released from pancreas

lowers blood sugar

stores fat

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how many americans are pre diabetic/diabetic

1/3 have pre diabetes

1/10 americans have diabetes

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incidence/prevalence of diabetes

most common endocrine/metabolic disorder

type II more common (90%)

increasing obesity/sedentary lifestyle

happening in younger and younger individuals

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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

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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)

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pathogenesis of type I diabetes

inability to produce and secrete adequate insulin to use glucise

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pathogenesis of type II diabetes

inadequate response of insulin receptors to insulin

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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

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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)

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what are the 3 types of neuropathies diabetes can lead to

sensory
motor weakness of mm innervated by peripheral nn
autonomic

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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

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what is motor neuropathy

weakness of mm innervated by the involved peripheral n

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what is an autonomic neuropathy

affects multiple systems, particularly cardiovascular

diminished pulses
necrosis
poor healing
stroke
cardiac dz

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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

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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

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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

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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