DM Foot problems Flashcards
(47 cards)
What are the three major complications that arise from DM?
- Peripheral neuropathy
- Autonomic Neuropathy
- PVD
What are the arteries that are classically associated with PVD?
Tibial
Peroneal (fibular)
What are the three major contributing factors of PVD in DM?
- Smoking
- HTN
- Hyperlipidema
What happens to bone with autonomic dysfunction of the foot?
Dilation of vessels, causing increased bone resorption
charcot foot
What happens to the skin of the foot with autonomic dysfunction of the foot?
Dry, cracked skin
What are the immune consequences of PVD?
Impaired wound healing
What are the components of metabolic syndrome?
- Hyperinsulinemia
- Hypertriglyceridemia
- HTN
- Central obesity
What are the ssx of PVD?
- Atrophic skin
- Rest pain
- Claudication
- Pallor on elevation
What happens to the aorta and medium sized vessels with PVD?
Accelerated atherosclerosis
What are the major PE findings of PVD?
- Diminished pulses
- Cap refill time
- Skin atrophy
What is the inexpensive test that can be used to evaluate for PVD?
Ankle brachial index
Greater than 0.50
What is the minimum value of the ABI and transcutaneous oxygen that is needed for healing in the foot?
More than 0.5
More than 30 mmHg
What is a normal ankle brachial index? Moderate obstruction?
Above 0.9
Moderate = 0.5-0.8
At what level of obstruction does loss of the arterial rebound with occur? What about loss of the reversal of blood flow
Mild obstruction
Moderate obstruction
What can cause an inaccurate ABI? Why?
Calcified vessels will lower the ratio, since they will not compress as readily
What happen to the waveform of the doppler US as you progress from normal to severe obstruction?
Normal = triphasic Mild = biphasic Moderate = monophasic Severe = loss of peaks
What is transcutaneous oxygen pressure measurement?
O2 levels in the arteries through the skin
Why may someone with a poor ABI have a normal transcutaneous oxygen pressure?
Collateral circulation
What are the invasive vascular exam that may be performed to assess for arterial oxygen? (3)
Arteriography
MRA
DSA
What are the causes of the increased ulceration risk with peripheral neuropathy, beside the loss of sensation and increased blood flow?
More pressure on the toes and bony prominences
What is “neuro-traumatic” theory of Charcot foot osteoarthropathy?
Exaggerated overuse injury coupled with loss of protective sensation
Allows for continued tissue destruction in
What is “neurovascular” theory of Charcot foot osteoarthropathy?
AV shunting leads to excessive bone resorption, contributing to fractures
What is stage 1 Charcot neuropathy?
The acute destructive phase, characterized by inflammation, joint effusion, and degradation of bone
What is stage 2 Charcot neuropathy?
Coalescence phase:
-Further bone/cartilage destruction, but initiation of sclerosis where cartilage has degraded, and fusion of bone fragments
