Week 2 Neuropathic Wounds

Question 1

what are some risk factors for neuropathic ulcers

Answer 1

DM, impaired healing, vascular disease, neuropathy, mechanical stress, impaired ROM, foot deformities and previous ulcer or amputation

Question 2

how does hyperglycemia affect healing

Answer 2

• bacteria proliferate rapidly in a high glucose environment,
• get impaired production and migration of neutrophils
• impaired chemotaxis, migration, mobility of macrophages, and impaired fibroblasts.
• deficient blocking of the enzymes that degrade tissue,
• endothelial dysfunction
• impaired epithelial migration.

Question 3

with neuropathic wounds, you have impaired healing and slower healing and a decreased ability to fight infection… how

Answer 3

higher risk of infection, and impaired ability to fight infections. You also get blunted s/s and hard to diagnosis and often mismanaged.

Question 4

what is tri-neuropathy

Answer 4

diabetic neuropathy which means you get sensory. motor and autonomic things, that are usually symmetrical and affects the distal nerves of the hands and feet.

Question 5

severity of tri-neuropathy increases with

Answer 5

age, disease duration over 10 years and glucose control

Question 6

what is the sensory part of the tri-neuropathy

Answer 6

poor awareness of trauma of the feet and occurs gradually. you get paresthesias and burning, tingling, aching and painful (sometimes, not always)

Question 7

what is the motor part of the tri-neuropathy

Answer 7

paralysis of the foot intrinsics, with increased plantar forces. Hallux valgus and claw toes

Question 8

what its he autonomic part

Answer 8

altered sweating (dry, less elastic and cracked skin), callus formation, increased pressure, and blood flow is shunted, so less perfusion, and vasodilation (increases blood to bone which causes calcium to leach out and then predisposes you for osteopenia)

Question 9

what is Charcot foot

Answer 9

fracture and dislocation deformity and abnormal presence of shear forces

Question 10

when might you suspect a Charcot foot

Answer 10

inflammation, edema, warm, bounding pulse, open wound

Question 11

what bout temperature might indicate a Charcot foot

Answer 11

temperature higher by 4-15 degrees without an ulcer,

Question 12

how do you diagnosis a Charcot foot

Answer 12

x-ray and MRI

Question 13

how do you treat Charcot foot

Answer 13

casting for 6-12 months, and TCC and boots

Question 14

lab values for neuropathic

Answer 14

lab values (A1C, glucose, pre-albumin)

Question 15

inspect the skin and nails… how will they look

Answer 15

dry, scaly skin with callus, warm

nails will be hypertrophic and fungus

Question 16

foot deformity with neuropathic

Answer 16

joint subluxation and dislocations

Question 17

what about a vascular screen with neuropathic

Answer 17

noninvasive, so use ABI

Question 18

neuropathic injuries and motor and ROM

Answer 18

• STR of ankle and foot muscles
• flexibility (DF ROM at least 10 degrees) (great tow ROM, metatarsal mobility)
• gait analysis with heel strike and movement through great tow

Question 19

how might we do sensory testing

Answer 19

monofilament, vibration

Question 20

when doing a 5.07 semis-weinstein monofilament test, what does > 1 absent mean

Answer 20

LOPS loss of protective sensation

Question 21

what might a leg length discrepancy mean

Answer 21

unequal WB and increased shear forces on the plantar portion

Question 22

why do we want to check shoes

Answer 22

nails, glass, rocks, and people may be walking on them and not knowing

Question 23

how do neuropathic ulcers look

Answer 23

round, punched out, and deep (may even probe to the bone).

Question 24

how does the peri wound of a neuropathic ulcer look

Answer 24

callus the surrounding skin will be dry and cracked

Question 25

where are neuropathic ulcers usually

Answer 25

on the plantar aspect, met heads and great toe

Question 26

is there drainage with a neuropathic ulcer

Answer 26

min to moderate

Question 27

what color granulation tissue

Answer 27

red-pale

Question 28

are ulcers painful

Answer 28

usually pain free

Question 29

how do we do a neuropathic wound exam

Answer 29

explore the wound bed, and look for tracts, tunnels and named structures, and for callus

Question 30

what is the classification Wagner grading scale

Answer 30

0- no open lesions (deformity or cellulitis)
1- superficial ulcer 
2- deep ulcer to tendon capsule or bone
3- deep ulcer with abscess 
4- localized gangrene 
5- gangrene of the entire foot