wk 12- offloading and charcot, neuro, osteo, arthropathy Flashcards
offloading devices for non plantar DFU
- removable ankle high device
- footwear modifications
- toe spacers
- orthoses
offloading device for a plantar forefoot/midfoot DFU WITH mild ischaemia OR infection
non removable knee high offloading device (total contact cast)
offloading device for plantar forefoot and midfoot DFU with mod ischaemia or infection OR mild ischaemia AND mild infection
removable knee high offloading device
offloading device for plantar forefoot /midfoot DFU with mod ischemia AND mod infection OR severe ischaemia or severe infection
removable ankle high offloading device
(CAM walker, orthowedge, post op shoe)
or use felted foam with appropriate fitting footwear
plantar heel DFU offloading devices
knee high offloading devices, cast or removable
what reduction in max plantar pressure is required to prevent foot ulcers
at least 30%
how are ulcers created in neuropathic feet
- increased duration of pressure (low pressure for prolonged amounts of time)
- increased magnitude of pressure (high pressure for short period of time)
- increased number of pressures (repititions of pressure resulting in mechanical fatigue)
how can you assess pressure in ulcers/high risk feet
PEDAR
Whats the gold standard for offloading
total contact cast
ankle high offloading devices are effective at reducing plantar pressures at the
forefoot
especially compared to footwear interventions
what should you give someone who isnt adherent
non removable cast/walker
if a knee high device is contraindicated what else can you use
a removable ankle high device
what shouldnt you use to offload a forefoot/midfoot plantar ulcer
conventional therapeutic footwear alone.
if removable ankle high is contraindicated what next
- semi compressed felt in post op shoe
- semi compressed felt in existing footwear (must accomodate felt size)
therapeutic footwear worn at home?
yes
length of footwear for diabetics should be
1-2cm longer than foot length
rocker sole for diabetics
reduces plantar pressures, good at preventing ulceration
width of shoe should be
equal to the width of the foot at the MTP joints
when should you evaluate fit of shoes on a person
standing, at the end of day when they may have foot swellign
how often do you need to reevaluate offloading devices at qut
8-12 weeks after dispense
charcot foot
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
pathology of charcot
prolonged osteoclastic activity
clinical features of charcot
erythema, oedema, bounding pulses, increased temp, deformity
treatment for charcot
offload with TCC, CAM, splint
