Diabetic Foot Ulcers

Front 1

what does diabetes damage

Back 1

afferent neurobiology of the peripheral neurobiology of the peripheral neurovascular system

Front 2

Diabetes often results in what

Back 2

loss of protective sensation, foot and digital deformities, or a marked reduction in a vascular perfusion of LE

Front 3

Describe the type of foot that is at the highest disk for ulcers

Back 3

biomechanically altered, insensate, dysvascular.

Front 4

Injury to diabetic foot is most commonly caused by what

Back 4

inflammatory disruption that occurs with repetitive mechanical stress

Front 5

Why is moderate pressure not recognized by a patient with diabetic foot

Back 5

peripheral neuropathy ad loss of protective sensation

Front 6

what two characteristics make diabetic foot uniquely susceptible to complications

Back 6

vascular insufficiency and altered response

Front 7

what does distal symmetrical polyneuropathies predict

Back 7

one of the most important predictors of ulcers and amputations

Front 8

How can the development of neuropathy be delayed

Back 8

maintaining glycemic control levels to as near normal as possible

Front 9

Name the three types of peripheral neuropathy

Back 9

motor neuropathy
sensory neuropathy
autonomic neuropathy

Front 10

What fibers are damaged with motor neuropathy

Back 10

large fibers

Front 11

what results from motor neuropathy

Back 11

intrinsic muscles of foot atrophy and weaken
Loss of ROM in ankle
imbalances in muscle alignment in foot and LE
abnormally high peak pressure over bony prominences

Front 12

what can result do to imbalance in muscle alignment of the LE

Back 12

Pes cavus or planus, hammer toes, claw toes

Front 13

what metatarsal heads commonly have a high peak pressure over

Back 13

1 and 5

Front 14

have a high peak pressure over bony prominences can lead to what

Back 14

increased risk of blisters or callus

Front 15

sensory neuropathy is due to damage to what

Back 15

small nerve fibers

Front 16

damage to small nerve fibers may result in what

Back 16

impaired joint proprioception, diminshed skin sensation and paresthesias

Front 17

when a pt has sensory neuropathy, the body is insensitive to what

Back 17

inflammation, pressure of callus or foreign body, pain of minor trauma, friction of poorly fitting shoes and continues to walk on the pressure points causing increased damage

Front 18

Sensory neuropathy can ultimately result in what

Back 18

subcutaneous tissue damage but because of sensory deficits, discomfort not perceived until tissue damage is deep

Front 19

Damage to what leads to autonomic neuropathy

Back 19

large nerve fibers and sympathetic ganglia

Front 20

Having damage to large nerve fibers and sympathetic ganglia results in what

Back 20

decreased production of sweat and oil in the skin causing it to be dry and inelastic

Front 21

what is the central point of origin for ulceration

Back 21

where scaling and fissuring occur

Front 22

other than neuropathy what other factors contribute to having diabetic foot ulcers

Back 22

obesity
visual loss
general joint limitation
poorly fitting shoes

Front 23

Describe the clinical features for having ulcers on a diabetic foot:
location of ulcer

Back 23

plantar surface

Front 24

Describe the clinical features for having ulcers on a diabetic foot:
shape

Back 24

round, ovoid

Front 25

Describe the clinical features for having ulcers on a diabetic foot:
appearance of periwound

Back 25

surrounded by callus

Front 26

Describe the clinical features for having ulcers on a diabetic foot:
sensation

Back 26

diminshed or absent

Front 27

why is blood glucose level important to be normal in a pt with a wound healing

Back 27

having too high or too low will delay the wound healing process

Front 28

having a elevated blood glucose will cause what for wound healing

Back 28

cell walls will become rigid, impairing blood flow through the critical small vessels at the wound surfaec and impeding RBC permeability and flow

Front 29

What does impaired hemoglobin release result in

Back 29

oxygen and nutrient deficits in the wound

Front 30

why are diabeteic infections take longer to heal

Back 30

delayed macrophage introduction and diminished leukocyte migration

Front 31

delayed macrophage introduction and diminished leukocyte migration will cause what

Back 31

prolonged inflammatory phase in wound healing cascade

Front 32

What are the factors that are associated with patients with diabetes

Back 32

elevated plantar pressure,
hx of amputations
presence of diabetes >10 years
foot deformities
male
poor diabetes control
one or more subjective symptoms of neuropathy
elevated vibration perception threshold (>25V)

Front 33

When assessing footwear, what do you need to look at

Back 33

look inside
assessed during weight-bearing
proper fit and adequate pressure reduction
wear pattern
inserts

Front 34

describe the appearance of high stress areas

Back 34

red, warm, swollen, callus

Front 35

what do you need to inspect when looking at the foot

Back 35

high stress areas
between toes and from toe to heel comparing to other side
toe nails
changes in color, pigmentation, texture and turgor
presence of calluses and their location, size and color

Front 36

what do you want to analyze in terms of the fat pads

Back 36

you want to make sure that the fat pads don't move anteriorly

Front 37

describe charcot foot

Back 37

occurs in a small % of pts with diabetes.
collapse of foot arch resulting in rocker sole, midsole ulceration, shortened foot length

Front 38

What is typical of deep tendon reflexes in patients with diabetes

Back 38

Diminished LE>UE, distal >proximal

Front 39

Where do you check for vibration at

Back 39

1st and 5th metatarsal heads, base of 5th metatarsal, medial and lateral malleoli

Front 40

what do you need to test for/screen for in terms of vascular

Back 40

peripheral pulse, ABI, capillary refill time and intermittent claudication.

Front 41

If the reading of the ABI is >1.3 it may indicate what

Back 41

it could be a false reading that is due to calcification inner arterial walls

Front 42

What are the implications of edema for a patient with edema

Back 42

you need to find out the cause of it. B/C if it is due to CHF and you had compression, you will make the pts condition worse

Front 43

What type of gait abnormalities are you more likely to see with patients with diabetes

Back 43

wide BOS, "marching" gait, "slap foot", stepping pattern, because of decreased sensation have a difficult time with being able to sense where they are

Front 44

For the University of Texas Classification System for Diabetic Foot Wounds what does the following indicate:
Grade 1

Back 44

pre- or post ulcerative lesion

Front 45

For the University of Texas Classification System for Diabetic Foot Wounds what does the following indicate:
Grade 2

Back 45

superficial wound not involving tendon, capsule or bone

Front 46

For the University of Texas Classification System for Diabetic Foot Wounds what does the following indicate:
Grade 3

Back 46

wound penetrating to tendon or capsule

Front 47

For the University of Texas Classification System for Diabetic Foot Wounds what does the following indicate:
Grade 4

Back 47

wound penetrating to bone or joint

Front 48

For the University of Texas Classification System for Diabetic Foot Wounds what does the following indicate:
Stage A

Back 48

without infection or ischemia

Front 49

For the University of Texas Classification System for Diabetic Foot Wounds what does the following indicate:
Stage B

Back 49

with infection

Front 50

For the University of Texas Classification System for Diabetic Foot Wounds what does the following indicate:
Stage C

Back 50

With ischemia

Front 51

For the University of Texas Classification System for Diabetic Foot Wounds what does the following indicate:
Stage D

Back 51

with infection and ischemia

Front 52

What does the following mean for the Wagner Scale:
Grade 0

Back 52

No ulcer in a high risk foot.

Front 53

What does the following mean for the Wagner Scale:
Grade 1

Back 53

Superficial ulcer involving the full skin thickness but not underlying tissues.

Front 54

What does the following mean for the Wagner Scale:
Grade 2

Back 54

: Deep ulcer, penetrating down to ligaments and muscle, but no bone involvement or abscess formation.

Front 55

What does the following mean for the Wagner Scale:
Grade 3

Back 55

: Deep ulcer with cellulitis or abscess formation, often with osteomyelitis

Front 56

What does the following mean for the Wagner Scale:
Grade 4

Back 56

Localized gangrene.

Front 57

What does the following mean for the Wagner Scale:
Grade 5

Back 57

Extensive gangrene involving the whole foot.

Front 58

What is the management of diabetic foot ulcer

Back 58

determine if arterial insufficiency is present; if needs to be managed conservatively or with surgery

Front 59

T/F: off-loading is not important for wound healing

Back 59

False, is imperative

Front 60

what are the key components of ulcer management

Back 60

local wound care
limb protection and risk factor protection

Front 61

describe wound care for diabetic foot ulcer

Back 61

can use a commerical wound cleanser which does not need to be rinsed
or saline
Debride
cover

Front 62

What does commerical wound cleanser help with

Back 62

break bond between contaminants, necrotic tissue, and the surface of the wound

Front 63

what is hyperkeratosis

Back 63

heavy callus around border of ulcer

Front 64

why does the border of the ulcer need to be trimmed

Back 64

to promote epithelization and necrotic tissue

Front 65

what are the factors that should be considered when deciding the dressing type

Back 65

wound type, presence of exudate, surrounding skin conditions, likelihood of reinjury, and cost

Front 66

what are some adjunctive therapies

Back 66

negative pressure therapy, hyperbaric oxygen, growth factors, biological skin substitutes

Front 67

what are the growth factors that are used

Back 67

regranex=becaplermin (recombinate platelet-derived growth factor

Front 68

what topics can you educate the patient/caregiver

Back 68

proper skin/wound care and methods of preventing recurrence of ulcer, teach things for them need to compensate for because of changes in senses

Front 69

What would be the ideal foot care program for a patient with diabetes

Back 69

Check feet daily for erythema, edema, calluses
visit a podiatrist regularly
orthotics to redistribute weight.
wash with soap and buff, between the toes

Front 70

Why is off-loading so important

Back 70

reduce the pressure at the ulcer

Front 71

How do you convince patient to stay off of wound

Back 71

"wound result of repetitive pressure and every unprotected step is tearing wound apart."

Front 72

Describe what a total contact cast is

Back 72

minimally padded below-the-knee irremovable walking cast

Front 73

what patients would the total contact cast be appropriate for

Back 73

patients with NO infection, pure neuropathic ulcers because these will reduce healing rate

Front 74

why does the TCC work

Back 74

increases the surface area for weight bearing forces, reducing peak pressure at ulcer site; dissipates pressure, reduces edema in casted region, protects from direct trauma, forces patient to off-load

Front 75

What are the risk and complications of having a total contact cast

Back 75

superficial abrasions from movement of leg in cast, damaged case, improper application of cast, patient tampered with cast, fungal infections, decreased joint mobility after 6-8 weeks in cast, can't see wound, clumsy, heavy and hot

Front 76

What is the ideal application of TCC

Back 76

wear for 3 days, then one week, then change every 2 weeks until wound closure, then kept one for another 1-2 weeks to allow for wound maturation.

Front 77

What would you need to include for patient education for a total contact cast

Back 77

proper cast care
NOT putting objects in cast
NOT using the cast to strike objects
NOT removing the cast self
keeping the cast dry
inspecting for damage or drainage
Don/Doff cast shoe
worn whenever WB through cast
limit walking distance and standing time as much as possible

Front 78

Describe the removable walking boot

Back 78

using a conformer walking boot and then wrapping

Front 79

what is advantage of using a removable walking boot

Back 79

less expensive, protective inner sole can be replaced with wear, no special training for application, easily removed

Front 80

what is the disadvantage to the TCC

Back 80

patient can remove so no forced adherence

Front 81

describe half shoes

Back 81

orthowedge healing shoe
not well tolerated, difficult to walk in, causes pain in contralateral extremity, can be unsage if patient has postural instability

Front 82

PT management for patient with diabetic foot

Back 82

gait train with use of appropriate assistive device, treat any other problems identified in PT exam