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78 Cards in this Set
- Front
- Back
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If 24-26 million people in the US have diabetes, how many are NOT diagnosed?
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5-7 million
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Diabetics make up 4.2% of the population, but what percent of health care expenditures are spent on them?
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19.5%
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What percent of diabetic admissions are for foot issues?
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25%
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Besides foot ulceration, name six other characteristics / factors that increase the likelihood of LEA? (ADMNPRS)
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Age
Duration of diabetes Male Neuropathy Proteinuria Retinopathy Smoking |
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What percent of people with a BKA will die within 3 years?
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>50%!!
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In patients with LEA, what is the median survival for DM vs non DM?
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only 27.2 months (DM) vs 46.7 months
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What percent of people amubulate again after BKA?
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50-65%
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What percent of people ambulate again after AKA?
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10-30%
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what is the 30 day mortality for people with BKA vs AKA?
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BKA 5-8% and AKA 8-12%
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What are the two main types of neuropathy?
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vascular and sorbitol
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What tends to occur in neuropathy?
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a loss of myelinated and non myelinated nerves in a glove and stocking pattern
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Ulceration is a consequence of all three types ______, ______, & _______ neuropathy
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autonomic, sensory, and motor
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If a diabetic WITH neuropathy c/o pain, you should worry about _______.
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Infection
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What type of neuropathy is this: intrinsic muscle , imbalance , deformities (such as hammertoes etc), which results in increased pressure on ball of foot, toes, and heels
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Motor
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What kind of neuropathy is this: related to skin temp and sweating (resulting in dry, stiff skin), AV shunting can lead to ulceration
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autonomic
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What is tabes dorsalis?
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Slowly progressive degeneration of the spinal cord ; Among the terrible features of tabes dorsalis are lancinating lightning-like pain, ataxia (wobbliness), deterioration of the nerves to the eyes (the optic nerves) leading to blindness, urinary incontinence, loss of the sense of position, and degeneration of the joints (Charcot's joints).
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When was Charcot neuroarthropathy first notes?
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1868
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What are some of the more commonly associated condition seen in charcot neuroarthropathy? (LADSS)
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Leprosy
alcohol DM syphilis syringomyelia |
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what is the #1 cause of charcot worldwide and #1 cause in US
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WW = leprosy
US - DM |
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how many stages of Charcot are there and what are they?
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4, number 0-3
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What percent of DM pts will develop diabetic neuroarthropathy?
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1-2.5%
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Describe features of diabetic neuroarthropathy?
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rapid onset
painless and severe joint destruction assoc with fx and dislocation erythema Profound swelling NON INFECTIOUS |
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what are of the foot is most often affected with diabetic neuroarthropathy?
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ankle and midfoot
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what is the pathogenesis of diabetic Neuroarhropathy?
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repetitive stress with limited sensation
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During your assessment / eval, what 6 things would indicate its probably Charcot?
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1. absent fever
2. ulcer present 3. pain present 4. high WBC 5. high ESR 6. nml glucose |
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When you elevate a limb in charcot, what would you expect to see?
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the swelling decrease
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When you have an ulcer with exposed bone, what % of cases are actually infected (osteo) ?
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only 52%, so NOT ALWAYS infection
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What is the goal in charcot deformity?
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to makes a shoeable, plantargrade, and stable foot and ankle
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What is the gold standard to dx osteo in uclers?
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bone bx
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what is the role of biphosphonates in charcot?
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may lessen time of disease some
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If ulcerated diabetic neuroarthropathy, what is the gold standard of tx?
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TOTAL CONTACT CAST
other options- crowboot, cam walker |
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how long may ulcerations typically last in diabetic neuroarthropathy?
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6-12 months in midfoot and 12-18 months in ankle
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when is surgery necessary in ulcers?
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if bony deformity present and recurrent ulcer OR if infected
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What percent of benign ulcerations have osteo underlying (therefore we should work them up)?
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70%
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Do "clean" ulcers still need evaluated in diabetics?
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yes
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What type of scans are really good at picking up infections but only available in limited areas (cleveland)?
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medullary scans
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What is the treatments for OM?
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debridement and IV antbx x 4-6 weeks
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What should you make sure you check BEFORE amputation to help avoid post amputation gangrene?
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circulation (needs to be adequate to get to surgical site)
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What are some good, broad spectrum drugs to consider in the use of diabetic ulcers / infections? (before sens avail)
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augmentin, omnicef, clinda
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What should you use to check protective sensation in a diabetic?
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5.07 Semmes Weinstein monofilament
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What might you see on xray to indicate a DM might have circ problems?
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calcifications
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List 5 skin / general findings that are MEDICARE CRITERIA for toenails getting cut by podiatrist.
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1. loss of hair
2. thin skin 3. pallor on trendelenburg 4. thick nails 5. claudication |
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What are some impt vascular assessment tools for the diabetic pt?
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pulses (dopple prn)
digital plethsmography ABI |
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If untreated, what is the 5 year mortality for PAD alone?
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60%
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What is a "cavus foot" that we should be noting on exam?
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a high arched foot
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What is the most commonly injured joint in the body?
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the ankle
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What are the 3 ligaments that support the ankle?
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medial
lateral interosseuous |
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What is the most common type of injury causing an ankle sprain?
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inversion sprain (so ankle joint rolls in, lateral foot on ground, medial up in air)
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the medial ligaments of the ankle (# ___) wind together to form the _______ ligament.
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4-6 ligaments; form deltoid ligament
- NOT COMMONLY INJURED |
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what is the most common lateral ligament injured?
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ATF (anterior talofibular ligament)
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What is the strongest lateral ankle ligament?
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the CF (calcaneofibular)
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what are the 3 lateral ankle ligaments?
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anterior talofibular (ATF)
calcaneofibular (CF) posterior talofibular (PTF) |
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What are the names of the two ligaments that connect the tib / fib and what are they called as a group?
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Anterior inf tibiofibular and posterior inf tibiofibular - they are called the SYNDESMOTIC LIGAMENTS
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What ligament are injured in high ankles sprains?
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the syndesmotic ligaments (aitf & pitf)
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is a flat foot or a high arch foot more likely to sprain?
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high arch
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External rotation ankle injury are a clue that the injury might be what type of sprain?
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a high ankle sprain
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What are the ROM nmls for:
dorsiflexion - plantar flexion- inversion - eversion - |
10%
45% 20-30% 10-20% |
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What does an ankle anterior drawer test for?
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ATF injury
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What does a talar tilt test check for ?
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CF injury
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What does a squeeze test check for?
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syndesmotic injury
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how many views should you get on xray of ankle?
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at least two (AP and lateral)
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What is one of the most difficulty foot / ankle fractures to heal?
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Jones fracture
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What are the 3 classifcations (grades) of ankle sprains?
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I - stretching
II - partial tear III - complete |
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What type of ankle ligament injury has a DELAYED RECOVERY?
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medial or syndesmotic injuries
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If no medial or syndesmotic injuries, what is the mainstay of ankle sprain tx?
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RICEN with protected wt bearing
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In ankle sprains, when is surgery considered?
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- for high performance athletes
-chronic sprainers -syndesmotic injury |
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When should you refer ankle sprains?
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1. fracture
2. high sprain 3. medial 4. people not making progress or no imprv over 4-6 weeks of tx 5. chronic sprainers 6. suspicious injuries 7. severe injury |
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what causes pain in plantar fasciitis?
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inflammation, tears, degeneration of plantar fascia where it attaches to the medial process of the calcaneous
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What does wt, activity, and standing have to do with plantar fasciitis?
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increased wt gain recent, incr standing, incr activity can all contribute to it
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Where is most common site of plantar fasciitis?
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medial calc tuberosity and prox 1-2 cm of plantar fascia but also can be mid arch
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is radiation usual with plantar fasciitis?
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no, and if present it should make you consider an alternative dx
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Plantar fasciitis is a subjective diagnosis - how is it made?
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pain on medial calcaneal tuberosity and fascia
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Test for plantar fasciitis
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lateral xray (spurs, stress fx, bone tumor)
US, MRI , bone scan - sero + / - arthritis |
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what percent of pts with Plantar fasciitis respond to conservative tx?
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90%
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What are basics of conservative tx for PF?
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- modify to fit pt
- reduce inflammation (NSAIDS) -stretch (at least TID) - improve shoe gear (possible heel cups, night splints) |
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What are some additional options for PF tx?
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PT, US, prefab inserts, custom orthotics, steroids, avoid barefooting, surgery (not freq used), coablation
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what is one new tx for PF NOT yet covered by insurance?
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ESWT
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When should one refer a PF case
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- pain resistant to conservative tx
-biomechanical foot abn - suspected fx - serogneg or seropos disease - nerve entrapment -tx > 8 weeks without relief |
