wk 9- high risk foot intro

Question 1

high risk foot is what

Answer 1

where neuropathy, ischemia, and infection lead to ulceration of the foot

this occurs when two or more risk factors are present

Question 2

is a high risk foot a diabetic foot?

Answer 2

a high risk foot is a foot with pathologies that increase the risk of ulceration/amputation

diabetes makes up 75% of foot complications
then RA/ other systemic pathologies (15%) then PAD without DM (10%)

Question 3

what are the complications of diabetes with relation to high risk

Answer 3

1. peripheral neuropathy
   2.peripheral vascular disease
2. abnormal cellular / inflammatory pathways

Question 4

IWGDF high risk foot status

Answer 4

0- no lops or pad : examine annually, very low risk

1- lops or pad : examine 6-12months, low risk

2- lops and pad, lops and deformity, pad and deformity : examine every 3-6 months, mod risk

3-lops or pad and one of following
-history of ulcer
-amputation
-end stage renal disease
examine 1-3months, high risk

Question 5

what location of ulcer has a high recurrence rate

Answer 5

plantar

Question 6

almost half of diabetic foot ulcers with recur within ?

Answer 6

1 year

Question 7

what complications do diabetes have

Answer 7

macrovascular: PVD, CHD, stroke

microvascular:
retinopathy
nephropathy
neuropathy

these are caused by atherosclerosis, high blood viscosity, glycosylated haemoglobin, thickened basement membrane

Question 8

types of neuropathy

Answer 8

loss of protective sensation

motor neuropathy : weakness of muscles, deformity

autonomic neuropathy: reduced sweating (dry skin, fissures, cracking, callus)

Question 9

HBA1C target for most patients with diabetes is

Answer 9

7% or less

Question 10

what are microvascular complications linked to

Answer 10

ulceration

Question 11

each 1% increase in hba1c means what

Answer 11

a decrease in wound healing

Question 12

stages of wound healing

Answer 12

1. bleeding (immediate)
2. inflammation (appears within week 1)
3. proliferation (1st week- months)
4. remodelling (begins 3 weeks- 2 years)

this is normal wound healing process

these stages overlap eachother

Question 13

what affects wound healing

Answer 13

infection
lack of blood supply
wound tension
wound pressure
deficencies
systemic conditions
immunisuppressant conditions/medications
age

Question 14

how does hypergylcaemia hinder wound healing

Answer 14

promotes endothelial dysfunction
vascular leakage
impiared angiogenesis
activates inflammatory response
immunosuppressant
reduces WBC function

Question 15

key areas to prevention

Answer 15

1. identifying at risk foot
   -minimum monofilament and pedal pulses assessed
2. regular inspection/examination
   -know your IWGDF status and frequency to screen
3. education of patient, family, health care team
   -footwear, inspect, wash, emollients, cut toe nails straight across, seek care, etc
4. ensuring routine wearing of appropriate footwear
   includes offloading (reduce 30% of peak pressures)
5. treating risk factors for ulceration
   -infection
   -callous
   -offloading
   -systemic conditions