wk 12- offloading and charcot, neuro, osteo, arthropathy

Question 1

offloading devices for non plantar DFU

Answer 1

1. removable ankle high device
2. footwear modifications
3. toe spacers
4. orthoses

Question 2

offloading device for a plantar forefoot/midfoot DFU WITH mild ischaemia OR infection

Answer 2

non removable knee high offloading device (total contact cast)

Question 3

offloading device for plantar forefoot and midfoot DFU with mod ischaemia or infection OR mild ischaemia AND mild infection

Answer 3

removable knee high offloading device

Question 4

offloading device for plantar forefoot /midfoot DFU with mod ischemia AND mod infection OR severe ischaemia or severe infection

Answer 4

removable ankle high offloading device
(CAM walker, orthowedge, post op shoe)

or use felted foam with appropriate fitting footwear

Question 5

plantar heel DFU offloading devices

Answer 5

knee high offloading devices, cast or removable

Question 6

what reduction in max plantar pressure is required to prevent foot ulcers

Answer 6

at least 30%

Question 7

how are ulcers created in neuropathic feet

Answer 7

1. increased duration of pressure (low pressure for prolonged amounts of time)
2. increased magnitude of pressure (high pressure for short period of time)
3. increased number of pressures (repititions of pressure resulting in mechanical fatigue)

Question 8

how can you assess pressure in ulcers/high risk feet

Answer 8

PEDAR

Question 9

Whats the gold standard for offloading

Answer 9

total contact cast

Question 10

ankle high offloading devices are effective at reducing plantar pressures at the

Answer 10

forefoot

especially compared to footwear interventions

Question 11

what should you give someone who isnt adherent

Answer 11

non removable cast/walker

Question 12

if a knee high device is contraindicated what else can you use

Answer 12

a removable ankle high device

Question 13

what shouldnt you use to offload a forefoot/midfoot plantar ulcer

Answer 13

conventional therapeutic footwear alone.

Question 14

if removable ankle high is contraindicated what next

Answer 14

1. semi compressed felt in post op shoe
2. semi compressed felt in existing footwear (must accomodate felt size)

Question 15

therapeutic footwear worn at home?

Answer 15

yes

Question 16

length of footwear for diabetics should be

Answer 16

1-2cm longer than foot length

Question 17

rocker sole for diabetics

Answer 17

reduces plantar pressures, good at preventing ulceration

Question 18

width of shoe should be

Answer 18

equal to the width of the foot at the MTP joints

Question 19

when should you evaluate fit of shoes on a person

Answer 19

standing, at the end of day when they may have foot swellign

Question 20

how often do you need to reevaluate offloading devices at qut

Answer 20

8-12 weeks after dispense

Question 21

charcot foot

Answer 21

inflammatory process that affects bones, joints, soft tissue in the feet. it develops as a result of neuropathy caused by diabetes or other nerve damage

Question 22

pathology of charcot

Answer 22

prolonged osteoclastic activity

Question 23

clinical features of charcot

Answer 23

erythema, oedema, bounding pulses, increased temp, deformity

Question 24

treatment for charcot

Answer 24

offload with TCC, CAM, splint

Question 25

bones and joints most affects in charcots

Answer 25

medial cuneiform- medial dislocation

2-5th tarsometatarsal joints - lateral dislocation

talonavicular joint- downward dislocation

Question 26

classification of charcot

Answer 26

grade 0- joint oedema, negative bone scan, xray
1- joint oedema, x ray show joint dislocations
2- decreased oedema, x ray show fragments and absorption of debris
3- no oedema, x ray shows remodeling of fracture fragments

Question 27

x ray findings of charcot

Answer 27

6 D’s

dense bones (subchondral sclerosis)

degeneration

destruction of articular cartilage

deformity (penil point deformity of met heads)

debris (loose bodies)

dislocation

Question 28

if x ray is normal in charcot then what

Answer 28

MRI

inflammation of soft tissue and of bone marrow

Question 29

CROW walker

Answer 29

charcot restraint orthotic walker

Question 30

other conditions at risk of ulcers

Answer 30

diabetes
charcot
rheumatoid arthritis