The Neuropathic Foot

Question 1

Q: What % of those with diabetes will develop neuropathy?

Answer 1

50%

Question 2

T/F: Neuropathy is implicated in 25% of non-traumatic amputations.

Answer 2

False, 50-75%

Question 3

Q: What are the mortality rates 1 and 5 years after amputation?

Answer 3

40%, 80%

Question 4

Content: Causes of neuropathy (6)

Answer 4

1. Diabetes
2. Tumor, trauma
3. Autoimmune disease
4. Vitamin B, E, niacin deficiency
5. Exposure to toxins
6. Infection

Question 5

Content: 4 types of neuropathy

Answer 5

1. Peripheral - UE/LE
2. Autonomic - CVS, temp reg, bowel/bladder
3. Proximal - thigh, hip, core mm
4. Focal - sudden loss in one n. or group of n.

Question 6

Content: Foot Examination (3)

Answer 6

1. comprehensive foot exam should be completed at LEAST annually
2. those with neuropathy should have feet visualized every medical visit
3. those with diabetes should check their feet each day

Question 7

Content: Goals of the foot exam (4)

Answer 7

1. Est. history/diagnostic factors
2. Identify risks
3. Intervention
4. Education

Question 8

Q: _________ involvement in foot neuropathy is __________.

Answer 8

Early, crucial

Question 9

Q: What habit can increase your risk of neuropathy?

Answer 9

smoking (current or past)

Question 10

Content: SE for foot neuropathy (7)

Answer 10

1. Contributing diagnosis
2. PMH/social factors
3. Medications
4. Complications
5. Hx of LE surgery, ulcer, amputation
6. Current or past smoker
7. HbA1c (diabetes)

Question 11

Content: OE for foot neuropathy (5)

Answer 11

1. Condition of skin, hair, toenails
2. Deformities
3. Pulses
4. Sensation
5. Shoe wear

Question 12

Content: Skin (3)

Answer 12

1. Think, shiny, brawny and/or frail
2. Dry
3. Calluses/wounds

Question 13

Content: Hair

Answer 13

May be present or absent

Question 14

Content: Toenails (3)

Answer 14

1. Thickened
2. Deformed
3. Ingrown

Question 15

Content: Four neuropathy deformities (4)

Answer 15

1. Prominent metatarsal heads
2. Hammer/claw toes
3. Hallux Valgus/bunions
4. Charcot Foot

Question 16

Diagram: Identify the Deformity

Answer 16

Claw toes

Question 17

Diagram: Identify the Deformity

Answer 17

Hammer toe

Question 18

Diagram: Identify the Deformity

Answer 18

Upper = corn

Lower = callus

Question 19

Diagram: Identify the Deformity

Answer 19

Hallux Valgus

Question 20

Content: Charcot Arthropathy (4)

Answer 20

1. Progressive bone destruction and ligament damage leading to arch colllapse and impaired skin integrity
2. Affects abot 9% of those with diabetes
3. Unclear if etiology is neurotraumatic, neurovascular, or both
4. Generally treated with complete immbolizations in a total contact cast with protected WB

Question 21

Q: What 3 pulses should you check during a foot exam?

Answer 21

1. Posterior tibilais
2. Dorsal pedis
3. Ankle brachial index (ABI)

Question 22

Cotent: ABI Scale (6 parts)

Answer 22

> 1.2 = vessels are incompressible, consider toe brachial indexes

1. 0-1.2 = normal
2. 9-0.99 = acceptable

< 0.9 = arterial disease

0.5-0.8 = intermittent claudication

< 0.5 = severe arterial disease

Question 23

Content: Sensation assessment (2)

Answer 23

1. Semmes Weinstein Monofilament (10 locations)
2. Vibratory sensation (128 Hz tuning fork, latency > 10 sec = sensory loss)

Question 24

Content: Assessment - Low Risk Foot Neuropathy (4)

Answer 24

1. Preserved sensation
2. No defromity
3. Intact circulation

4 Tx: Annual foot exam, education, good footwear

Question 25

Content: Assessment - High Risk Foot Neuropathy (6)

Answer 25

1. Sensory loss 2. Deformity 3. Vascular disease 4. Callus formation 5. Hx of ulcer or amputation 6. Tx: comprehensive assessment, education, diabetic shoe

Question 26

Content: Education (4)

Answer 26

1. General diabetes self care 2. Foot/skin care 3. Daily skin checks 4. Proper footwear (breathable, adjustable, wide toe box, good support)

Question 27

Content: Ulcer intervention (4)

Answer 27

1. Debulk callus 2. Control moisture 3. Decrease infection risk 4. Edema management

Question 28

Content: Offloading (5)

Answer 28

1. Total contact casts (change ever 1-2 wks) 2. Orthotics/walking boots 3. Surgical shoes 4. Dressings 5. Cutouts

Question 29

Q: How should you elevate a pts. heels?

Answer 29

With pillow under calves

Question 30

Content: Foot Care Education (6)

Answer 30

1. Check feet daily 2. ALWAYS wear shoes 3. No lotion/oil between toes 4. Keep nails clipped 5. Manage calluses 6. Report changes immediately

Question 31

Content: Exercise recommendations for foot neuropathy

Answer 31

At least 30 min most days - consider foot integrity

Question 32

Content: Nutrition recommendations for foot neuropathy (4)

Answer 32

1. Montior BMI - stable or weight loss 2. Fresh fruits/veggies 3. Pre meal glucose 90-130 mg/dl 4. Post meal glucose 180 mg/dl

Question 33

Content: glycemic control recommendations for foot neuropathy

Answer 33

HbA1c goal of \< 6.5-7

Question 34

Q: What is HbA1c?

Answer 34

Average blood sugar over a peroid of 3 months

Question 35

Q: Who could you refer pts. with foot neuropathy to? (4)

Answer 35

1. Podiatry 2. Wound care 3. Nurse educator 4. Dietician

Question 36

Defn: Claw toe

Answer 36

Hyper extension of MTP with PIP/DIP flexion

Question 37

Defn: Hammer toe

Answer 37

Hyperextension of MTP and DIP