Week 2 Neuropathic Wounds Flashcards
what are some risk factors for neuropathic ulcers
DM, impaired healing, vascular disease, neuropathy, mechanical stress, impaired ROM, foot deformities and previous ulcer or amputation
how does hyperglycemia affect healing
- bacteria proliferate rapidly in a high glucose environment,
- get impaired production and migration of neutrophils
- impaired chemotaxis, migration, mobility of macrophages, and impaired fibroblasts.
- deficient blocking of the enzymes that degrade tissue,
- endothelial dysfunction
- impaired epithelial migration.
with neuropathic wounds, you have impaired healing and slower healing and a decreased ability to fight infection… how
higher risk of infection, and impaired ability to fight infections. You also get blunted s/s and hard to diagnosis and often mismanaged.
what is tri-neuropathy
diabetic neuropathy which means you get sensory. motor and autonomic things, that are usually symmetrical and affects the distal nerves of the hands and feet.
severity of tri-neuropathy increases with
age, disease duration over 10 years and glucose control
what is the sensory part of the tri-neuropathy
poor awareness of trauma of the feet and occurs gradually. you get paresthesias and burning, tingling, aching and painful (sometimes, not always)
what is the motor part of the tri-neuropathy
paralysis of the foot intrinsics, with increased plantar forces. Hallux valgus and claw toes
what its he autonomic part
altered sweating (dry, less elastic and cracked skin), callus formation, increased pressure, and blood flow is shunted, so less perfusion, and vasodilation (increases blood to bone which causes calcium to leach out and then predisposes you for osteopenia)
what is Charcot foot
fracture and dislocation deformity and abnormal presence of shear forces
when might you suspect a Charcot foot
inflammation, edema, warm, bounding pulse, open wound
what bout temperature might indicate a Charcot foot
temperature higher by 4-15 degrees without an ulcer,
how do you diagnosis a Charcot foot
x-ray and MRI
how do you treat Charcot foot
casting for 6-12 months, and TCC and boots
lab values for neuropathic
lab values (A1C, glucose, pre-albumin)
inspect the skin and nails… how will they look
dry, scaly skin with callus, warm
nails will be hypertrophic and fungus
foot deformity with neuropathic
joint subluxation and dislocations
what about a vascular screen with neuropathic
noninvasive, so use ABI
neuropathic injuries and motor and ROM
- STR of ankle and foot muscles
- flexibility (DF ROM at least 10 degrees) (great tow ROM, metatarsal mobility)
- gait analysis with heel strike and movement through great tow
how might we do sensory testing
monofilament, vibration
when doing a 5.07 semis-weinstein monofilament test, what does > 1 absent mean
LOPS loss of protective sensation
what might a leg length discrepancy mean
unequal WB and increased shear forces on the plantar portion
why do we want to check shoes
nails, glass, rocks, and people may be walking on them and not knowing
how do neuropathic ulcers look
round, punched out, and deep (may even probe to the bone).
how does the peri wound of a neuropathic ulcer look
callus the surrounding skin will be dry and cracked
where are neuropathic ulcers usually
on the plantar aspect, met heads and great toe
is there drainage with a neuropathic ulcer
min to moderate
what color granulation tissue
red-pale
are ulcers painful
usually pain free
how do we do a neuropathic wound exam
explore the wound bed, and look for tracts, tunnels and named structures, and for callus
what is the classification Wagner grading scale
0- no open lesions (deformity or cellulitis) 1- superficial ulcer 2- deep ulcer to tendon capsule or bone 3- deep ulcer with abscess 4- localized gangrene 5- gangrene of the entire foot
