C14-FA

Question 1

Risk factors for diabetic foot ulcers (5)

Answer 1

1) uncontrolled hyperglycemia
2) inability to offload affected area
3) poor circulation
4) infection
5) poor nutrition

Question 2

What are 2 prognostic factors that suggest increased healing potential and one that indicates very poor chance of healing a diabetic ulcer.

Answer 2

1) serum albumin > 3.0 g/dL
2) total lymphocyte count > 1500 / mm^3

1) ABI < 0.3 = poor chance of healing
remember ABI can be falsely high because of calcified vessels.

Question 3

What three clinical and lab findings are predictive of and infected diabetic ulcer? (3)

Answer 3

1) size > 2 cm^2
2) probe to bone
3) ESR > 70

Question 4

How can you differentiate between cellulitis and Charcot foot?

Answer 4

erythema will decrease with elevation in Charcot foot and not in cellulitis

Question 5

What are the Eichenholtz classification of Charcot foot?

Answer 5

Stage 0 - joint edema xrays negative maybe +ve bone scan
Stage 1 - fragmentation - joint edema, osseus fragments with joint destruction
Stage 2 - Coalescence - decreased edema, coalescence of fragments and absorption of fine bone debris
Stage 3 Reconstruction - no local edema, xrays show consolidation & remodeling

Question 6

Conservative treatment of Charcot foot?

Answer 6

Offload pressure (TCC)
provide protective barrier
absorb exudate
provide moist environment

Question 7

What should you assess in diabetic forefoot ulcers and Charcot foot?

Answer 7

Assess Achilles & Silverskiold test

lengthen Achilles or perform strayer for gastroc

Question 8

Rough rule how long ulcer should take to heal?

Answer 8

80% by 8 weeks

Question 9

What are normal values of angles used to asses hallux valgus?

Answer 9

Hallux valgus angle (HVA) - N < 15 degrees
Inter-metatarsal angle (IMA) - N < 9 degrees
Distal metatarsal articular angle (DMMA) - N </= 10 degrees