wk 9- high risk foot intro

Question 1

what makes up a high risk foot

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

what medical conditions/pathologies are most common for high risk foot

Answer 2

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

Question 3

what are 3 predisposing factors for diabetics making them 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

pathway to amputation in diabetics

Answer 5

diabetes
neuropathy
ulceration
vascular impairment (delayed healing, immunocompromised)
infection
amputation

Question 6

what location of ulcer has a high recurrence rate

Answer 6

plantar ulcers

Question 7

almost half of diabetic foot ulcers with recur within ?

Answer 7

1 year

Question 8

what macro and micro complications do diabetes have

Answer 8

macrovascular: PVD, CHD, stroke

microvascular:
retinopathy
nephropathy
neuropathy

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

Question 9

types of neuropathy

Answer 9

loss of protective sensation

motor neuropathy : weakness of muscles, deformity

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

Question 10

HBA1C target for most patients with diabetes is

Answer 10

7% or less

Question 11

what are microvascular complications linked to

Answer 11

Uncontrolled glucose levels which increases risk of ulceration

Question 12

each 1% increase in hba1c means what

Answer 12

a decrease in wound healing

Question 13

stages of wound healing

Answer 13

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 14

what affects wound healing

Answer 14

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

Question 15

how does hypergylcaemia hinder wound healing

Answer 15

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

Question 16

what does this cause in diabetic wounds

Answer 16

delayed healing
risk of infection
risk of reulceration
insensate skin
low perfusion

Question 17

key areas to prevention

Answer 17

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

Question 18

minimum examination includes

Answer 18

1. 10g monofilament
2. pedal pulse palpation