-B06 Diabetes Presentation.

Question 0

Describe sensory effects of diabetes

Answer 0

Loss of protective sensation

High risk are toes and met heads (check with Weinnes Stein monofilament)

Question 1

Describe peripheral neuropathy

Answer 1

Loss/disruption of function

Numbness, pain or muscle weakness/wasting

Question 2

Describe motor effects of diabetes

Answer 2

Alteration of small muscle function

Claw toes, pes cavus foot(change in shape- increased plantar pressures)

Question 3

Describe autonomic changes with diabetes

Answer 3

Dry skin with fissuring

Distended veins on dorsum of foot

Question 4

Describe ischaemic ulcers

Answer 4

Common on distal toes
Lateral border of foot
Black
Dry and crusty - auto amputation

Question 5

Describe a neuropathic foot

Answer 5

Warm
Bounding pedal pulses
Numb
Plantar ulcers
Callus around ulcers
Distended dorsal veins
Dry skin

Question 6

Describe a neuro ischaemic foot

Answer 6

Cold
Absent pedal pulses
Painful
Marginated ulcers
Little callus
Pink foot
Atrophic skin

Question 7

Describe possible ulcer treatment options

Answer 7

Total contact cast
Air cast boot (walker boot) with TCI
Darco shoe - pressure relief
Prafo - for heel ulcers to offload heel

Question 8

What are the purpose of orthoses?

Answer 8

Pressure relief - ambulant and recumbent
Protection
Prophylaxis
Long term management- following active foot disease - pt 35-40% more likely to suffer further ulceration in 3yrs

Question 9

What prescription considerations are there?

Answer 9

Deformity(sig or non sig) modular/made to measure
Ambulation
Biomechanics
Ischaemia
Neuropathy
Pain
Environment

Question 10

What are the aspects of shoe design?

Answer 10

Seamless
Butterfly - toe puff
Soft leather
Padded collars
Rocker
Biomechanical considerations 
Insole design -no insole peak pressure greater than 500kPa, total contact insole less than 300kPa