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Assistive Tech > P - Neuropathic Foot > Flashcards

P - Neuropathic Foot Flashcards

(52 cards)

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1
Q

what are 2 major risk factors for neuropathic ulcer

A

loss of protective sensation
mechanical stress

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2
Q

what pathology is neuropathic ulceration the most common thing you will see in that patient population

A

DM

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3
Q

what does neuropathic ulceration result from in DM

A

poor glucose control

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4
Q

what are 2 characteristics of peripheral vascular dz that increase the risk of neuropathic ulceration

A

tissue breakdown
delayed wound healing

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5
Q

what is the sequence that leads to lower extremity amputation

A

minor injury
ulceration
faulty ulcer healing
infection
spreading
amputation

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6
Q

how does loss of protective sensation become a significant risk factor for neuropathic ulcers

A
  1. limited awareness of foot injury d/t dec sensation
  2. fail to initiate injury avoidance behaviors
  3. delay seeking medical treatment –> don’t realize there is a problem until it is significant
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7
Q

how is protective sensation tested

A

semmes-weinstein nylon 5.07 filament (10g of bending force)

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8
Q

what does the classification for risk of plantar ulcer and amp in neuropathic foot test

A

for loss of protective sensation

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9
Q

what are the category classifications for determining the risk of plantar ulceration and amp in the neuropathic foot

A

Category 0 - normal
- lo loss of protective sensation

Category 1 - loss of protective sensation (5.07 filament) at any areas of foot tested

Category 2 - loss of protective sensation and evidence of high presssure
- callus, deformity, joint limitation

Category 3 - hx of plantar ulceration

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10
Q

what are examples of evidence of high pressure that you might see in a category 2 (risk of plantar ulcer and amp)

A

callus

deformity
- bunion
- hammer toe
- claw toe

joint limitation
- lack of DF, midfoot motion, great toe ext
-> changes the mechanics of wt bearing and walking

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11
Q

what are types of mechanical factors (4)

A

pressure
shear
intrinsic
extrinsic

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12
Q

pressure vs shear mechanical factors

A

pressure = compressive
- vertical
- fairly easy to measure
- can measure barefoot or in shoe

shear = horizontal forces
- harder to measure

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13
Q

intrinsic vs extrinsic mechanical factors

A

intrinsic = bone or joint deformity

extrinsic = environment around foot (ie shoe)

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14
Q

what are intrinsic factors that are associated w high foot pressure

A

bone deformity
joint limitation

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15
Q

what are examples of bone deformities as an intrinsic mechanical factor (6)

A

bunion
claw toe
rearfoot varus/valgus
forefoot varus/valgus
charcot foot
partial amp

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16
Q

what is often the underlying component for a bone deformity

A

intrinsic ms weakness (small plantar intrinsics)

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17
Q

how does a bony deformity like a claw toe inc risk for ulceration

A

intrinsic ms weakness
MT heads become more prominent –> curl down and get more load and pressure on head –> MT head not designed to take load –> toe ulceration

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18
Q

what is a common location for ulcers associated with claw toe

A

toe ulcers

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19
Q

what determines the degree of ulceration in rearfoot and forefoot varus/valgus deformities

A

degree of compensation
- amt of ROM determines amt of compensation possible and thus determines amt of load

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20
Q

what risk factor for ulceration are rearfoot and forefoot varus/valgus deformities associated with

A

abnormal foot pressures

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21
Q

what is a charcot foot

Study These Flashcards
A

collapse of tarsal bones leading to midfoot ulceration
- radiographic changes at talonavicular &/or calcaneal cuboid joints

22
Q

what is type of path is charcot foot considered

Study These Flashcards
A

neuropathic osteoarthropathies

23
Q

where is ulceration expected in charcot foot

24
Q

where is ulceration expected in forefoot varus (compensated)

Study These Flashcards
A

1st or 5th MT head

25
where is ulceration expected in forefoot varus (uncompensated) and why
5th MT head rigid varus/inverted position, WBing stays in same lateral part of foot
26
what will active ortho pts w uncompensated forefoot varus present as often to PT
stress fx at 5th MT head - not meant to bear weight on the lateral side of our foot
27
where is ulceration expected in forefoot valgus and why
1st MT head valgus/everted position, medial side of forefoot, plantar side of big toe hitting ground early in gait
28
how is a partial amputation an intrinsic factor for ulceration
results in greater loading force on residual limb
29
how is great toe amputation an intrinsic factor for ulceration and why
inc pressure on remaining 1st ray segment - in gait heel strike, then pronate to push thru great toe transfer lesion - load shifts to 2nd MT -> not meant to take load
30
what limitations in motion can be intrinsic factors for ulceration
1st MTP ext PF 1st ray ankle DF
31
where is there increased stress with limited 1st MTP extension
IP joint during propulsion -> toe ulceration
32
what role does 1st MTP extension play in gait
need 65deg or > as move thru end of stance phase and heel comes off ground --> get DF there - if don't have that motion get load there and at toes earlier in gait cycle (propoulsion) or in later stance phase
33
where is there increased stress with rigid PF 1st ray
on 1st MT head
34
where is there increased stress with limited ankle DF (ankle equinus)
forefoot & risk of ulceration there
35
in general ortho pop, what problems will you see with limited ankle DF and why
when DF stops, heel comes up early and force on forefoot earlier in gait cycle and there for longer duration than meant to be -> metatarsalgia -> plantar surface foot pain
36
what are reasons for limited ankle DF
restricted talocrural joint restricted GS complex
37
motor neuropathy in peroneal n. distribution vs tibial n. distribution: common pt pop, ROM limitations, areas of inc stress
peroneal = forefoot - common in DM - foot equinus, hallux limitus *high forefoot stress* tibial = rear foot - common in SCI - limited PF *high stress at heel*
38
what are 3 levels of stress that can cause injury
momentary high repetitive mod cont low
39
what is the most common MOI to an insensate foot
repetitive mod stress from walking
40
what is the response to repetitive mod stress from walking in normal vs loss of protective sensation
normal - alter behavior - stop activity, shift WBing stress to another area no protective - cont activity - in same manner until # of reps exceeds a tolerable stress threshold resulting in skin breakdown
41
what are 2 integumentary concerns if person is at risk for ulceration
noncompliant dry skin hyperkeratosis (callus)
42
why is noncompliant dry skin an integumentary concern
breeding grounds for infection -> cracking & ulceration
43
what causes hyperkeratosis (callus)
response to tissue stress
44
why is hyperkeratosis (callus) an integumentary concern
inc pressure --> injury can mask underlying ulceration removal of heavy callus shown to dec foot pressure
45
what are causes of tissue atrophy
ms or connective tissue atrophy fat pad migration from bony areas
46
what can impact a person's ability to self inspect feet
obesity vision loss joint limitation (common in elderly)
47
what are 3 other factors impacting the risk for ulceration
inability to self inspect feet high impact exercise skin temperature
48
how can high impact exercise impact risk for ulceration and what is recommended in pts w DM
abnormal stress levels low impact exercise - stationary bike - swimming, UE exercies
49
what is an elevated skin temperature predictive of
ulceration and charcot fx in pts w DM
50
what can elevated skin temp be d/t
inflammation - soft tissue stress - infection or bony injury
51
what skin temperature change is significant
should be symmetric b/w limbs - significant if >1-2deg C
52
what are 4 steps to foot screening
test for sensory loss identify signs of skin lesions assess ROM and strength inspect footwear

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