Vascular Disorders (2) Flashcards
What is a diabetic foot?
Infection, ulceration, or destruction of deep tissues associated with neurological abnormalities and various degrees of peripheral vascular diseases in the lower limb
What is 40-60% of all non traumatic lower limb amputation caused by?
Diabetic foot
What are 85% of diabetic related foot amputation preceded by?
Foot ulcer
What are 4 out of 5 ulcers in diabetics precipitated by?
Trauma
What is the prevalence of foot ulcers in diabetics?
4-10%
What percentage of patients with type 2 diabetes have significant neuropathy?
50% (also at risk for foot ulcer)
What are major risk factors for a foot ulcer?
Sensorimotor and peripheral sympathetic neuropathy
What is the history of peripheral vascular disease?
Claudication that is relieved by rest
What would palpating a foot feel like in someone with peripheral vascular disease?
Cold
What pulses are examined in someone with peripheral vascular disease?
Dorsalis pedis and posterior tibial
Reactive hyperemia
Leg turns bright red when going from an elevated position to declining back to the ground
What is the monofilament test used for?
To test for neuropathy
What is known as the most important pre-ulcerative lesion stage?
Callus (removed by professional)
How should dry skin and fissure be treated?
With an emollient (reduce fissure margins with scalpel)
What are the stages of an ulcer development?
Callus formation
Subcutaneous hemorrhage
Breakdown of skin
Deep foot infection with osteomyelitis
What is neurogenic arthropathy?
Rapidly progressive degenerative arthritis that results from damaged nerves
What is another name for neurogenic arthropathy?
Charcot foot
What is severely impaired in Charcot foot?
Pain perception
Motor function
Proprioception of the foot
What does a loss of the motor and sensory functions in Charcot foot cause?
Minor traumas to go undetected leading to laxity, dislocations, bone erosions, cartilage damage, and deformity of the foot
What is the most common cause of Charcot foot?
Diabetes (60-70%)
When does the onset of Charcot foot occur?
When a patient has had diabetes for 15-20 years usually older than 50
What is an intervention for Charcot foot?
Total contact casting
What are the 5 pillars to prevent foot problems in diabetes?
Identification of high risk patient
Regular inspection and exam of foot and foot wear
Education of patient, family and health care providers
Appropriate foot wear
Treatment of non ulcerative pathology
