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MD2 Medicine > Foot Ulcer > Flashcards

Foot Ulcer Flashcards

1
Q

What are some causes of foot ulcers?

A 
Vasculitis
Trauma
Peripheral arterial disease
Venous insufficiency
Diabetes
Infectious
Dermatological condition
Malignancy
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2
Q

What proportion of people with diabetes will develop a foot complication?

A

25%

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3
Q

What is the commonest reason for hospitalisation in diabetes?

A

Foot disease

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4
Q

What is the commonest reason for amputations?

A

Diabetes

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5
Q

What factors in diabetes lead to lower limb ulceration?

A

Neuropathy
Trauma
Deformity

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6
Q

What are the clinical features of neuropathy?

A 
Loss of pressure/pain sensation
Dry skin
Reduced joint mobility
Structural deformity
Poor balance
Instability
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7
Q

What are the essential components to clinically assess, investigate, and manage, in order to treat and prevent recurrence of diabetic foot complications?

A 
Peripheral neuropathy
Peripheral vascular disease
Ulceration
Infection
Maximise diabetes control
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8
Q

What is the investigation of choice for diabetes-related critical limb ischaemia?

A

Angiography

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9
Q

What other investigations can be used to investigate peripheral vascular disease?

A

Duplex ultrasound
Toe pressures
Transcutaneous oxygen

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10
Q

How is infection diagnosed in ulcers?

A 
Clinical diagnosis
Purulent discharge
Or 2+ of
- Pain/tenderness
- Swelling
- Redness
- Warmth
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11
Q

How can the presence of osteomyelitis in an ulcer be determined?

A 
Ulcer duration
Recurrence of ulcer at same site
Post-surgical intervention
Sausage toe = toe swollen with non-pitting oedema, erythema, and obliteration of contours
Probe to bone/bone on show
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12
Q

What are the serological markers of infection?

A

Increase with severe infection

  • Random blood glucose
  • WCC
  • ESR
  • CRP
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13
Q

What is the association between alkaline phosphatase and osteomyelitis?

A

Rising ALP associated with osteomyelitis

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14
Q

How can osteomyelitis be diagnosed using imaging?

A

X-ray - time delay for changes to appear
Tc99 bone scan
- More sensitive than plain x-ray
- Non-specific
WBC scan - higher specificity than Tc99 scan but less sensitive
MRI - most useful in making diagnosis and defining extent of infection

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15
Q

What does obtaining a bone biopsy to diagnose osteomyelitis involve?

A

Obtained through uninfected skin
If able, discontinue Abx for 48 hours before
Histopathology for diagnosis
Microbiology for specific Abx therapy

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16
Q

What is the TIME principle in wound management?

A 
T = tissue non-viable > remove defective tissue
I = inflammation/infection > remove/reduce bacterial load
M = moisture imbalance > restore
E = edge of wound not advancing > address T/I/M issues
17
Q

What is the role of amputee rehabilitation?

A

Return person to maximal physical, psychological, social, and vocational function
Minimise disability and handicap
Improve prosthetic acquisition

18
Q

How can the foot claw in neuropathy?

A

Motor neuropathy > 1st set of nerves to go
Supply intrinsic muscles of feet
Larger, more proximal muscles overpower small muscles of foot > clawing of foot

19
Q

Why do people get dry feet in diabetic neuropathy?

A

Autonomic nerves become damaged > decreased innervation of sweat glands

20
Q

What does an examination of someone with possible neuropathy involve?

A

Watch way they walk
Are they looking at ground because of neuropathy?
If very vasculitic, can get cellulitis in foot - hot and swollen
- Poor vascular supply
- Decreased immune ability due to chronic disease
Pulses important to measure - gauge of macrovascular disease
Always look for signs of peripheral vascular disease

21
Q

What investigations are of use in peripheral vascular disease?

A

Ankle-brachial index not as useful anymore - absolute toe pressure considered more accurate now

  • <45 mmHg - outright ischaemia
  • Gauge of microvascular disease
22
Q

How does a handheld doppler ultrasound determine the presence of vascular disease?

A 
Number of sounds
- Triphasic doppler - normal
- Even 4 sounds normal
- Biphasic indicates element of calcification
- Monophasic indicates severe calcification
Flow
- Dampened
- Pulsatile
23
Q

How do you know if a wound is healing properly?

A

50% reduction in 4 weeks

24
Q

What is the management of a foot ulcer?

A 
SNAP
Daily foot checks
Measured, appropriate footwear
Referral to multidisciplinary teams
- Podiatry
- Orthotist
Avoid pressure ulcers
- Avoid tight covers
- Use air/foam mattress
Offload pressure when walking
- Total contact cast - works best as patient wears it all the time
- Cam walker
- Half shoe
Osteomyelitis
- 6 week course of Abx
- Repeat x-ray/other scan
25
Q

When should amputation be considered?

A

Severe systemic disease

MD2 Medicine (18 decks)

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