The diabetic foot Flashcards
what are the three main starting points for diabetes induced arthropathy?
- peripheral vascular disease
- autonomic neuropathy
- peripheral neuropathy
what is charcot?
deformed foot
arterial occlusion in diabetic arthropathy usually involves which arteries?
tibial
peroneal
what are the contributing factors to peripheral vascular disease?
smoking
hypertension
hyperlipidemia
what are the metabolic syndrome criteria?
- hyperinsulinemia or hyperglycemia
- hypertriglyceridemia
- hypertension
- obesity
- increased CRP and hyperuricemia
what % of diabetics over 50 have PVD?
30%
signs and symptoms of arterial occlusive disease
- claudication
- rest pain
- atrophic, shiny skin
- diminished hair growth
- dependent rubor
- pallor on elevation
ankle brachial index equation
ABI = lower extremity systolic / brachial artery systolic
what are the ABI values in normal, mild, moderate, and severe obstruction?
normal - above 0.9
mild - 0.8-0.9
moderate - 0.5-0.8
severe - below 0.5
how does calcification affect ABI readings in diabetics?
falsely elevated
what is the normal appearance of doppler wave form?
- triphasic
- bidirectional
- rapid upstroke / downstroke
- flow reversal
- arterial wall rebound
what is lost in mild / moderate / severe obstruction doppler wave forms?
- decreasing / loss of peak height
- absent flow reversal
- absent elastic rebound
what does transcutaneous oxygen pressure measure?
partial oxygen tension on skin surface
what are the motor complications of peripheral neuropathy?
- atrophy of intrinsic muscles
- flexion deformity
- pressure at metatarsal heads and toes
what are the autonomic complications of peripheral neuropathy?
- dyshidrosis and dry skin
- AV shunting (increase in bone and skin perfusion)
what are the two pathophysiology models for charcot athropathy?
neurotraumatic
neurovascular
what is the definition / etiology / result of neurotraumatic model of charcot arthropathy?
- cause: exaggerated overuse injury coupled with loss of protective sensation
- etiology: acute trauma or repetitive microtrauma
- result: lack of sensation allows continued tissue destruction resulting in fractures and dislocations
what is the definition / etiology / result of neurovascular model of charcot arthropathy?
- cause: vasomotor neuropathy in patients with intact blood flow
- etiology: AV shunting leads to excessive bone resorption and bone weakening
- result: fractures and dislocations with continued weight bearing
what are the stages of charcot?
- developmental
- coalescence
- reconstruction
which grade of ulcer has exposed bone? what else is present?
grade 3
infection (osteomyelitis)
which grade of ulcer has gangrenous changes of the forefoot? what treatment is required?
grade 4
debridement or amputation
which grade of ulcer involves gangrene of the entire foot? what is the likely treatment?
grade 5
amputation
which grade of ulcer has deeper lesions that have NOT penetrated to bone or a fascial plane?
grade 2
which grade of ulcer consists of superficial lesions?
grade 1
what is the best diagnostic test for arthropathy?
bone biopsy for histopathology and culture & sensitivity
the pathophysiology of the development of infected foot ulcers in diabetic patients relates to what two factors?
neuropathy
ischemia
what is one of the most serious problems of foot care in diabetic patients?
osteomyelitis
which bone condition shows WBCs in the ceretec scan?
acute osteomyelitis
