Week 2 Neuropathic Interventions

Question 1

how do we want to debride and treat

Answer 1

aggressive debridement and removal of callused, depending on vascular status and if there is eschar on the heel (you leave that alone)

Question 2

TF: you never debride stable callus hard on the heel

Answer 2

true, because the heel is hard to heal

Question 3

how else can we treat the injuries

Answer 3

moist and warm environment
offloading
monitor for infection
patient education and glucose control

Question 4

do we use whirlpool

Answer 4

no because they cannot soak their feet, and we should not be allowing germs to spread.

Question 5

what are some common interventions

Answer 5

silver (antimicrobial) dressings
growth factors
skin substitutes (Apligraft) MD application

Question 6

what is off loading

Answer 6

reduce the pressure, promote slow ambulation and facilitate normal gait.

Question 7

what are some things we can use to offload

Answer 7

Total contact cast (TCC)
Charcot restraint orthotic walker (CROW)
boots 
half shoes and AFOs
AD (FWW, SPC, crutches maybe)
wheelchair (last resort)

Question 8

what does a half shoe look like

Answer 8

heel is only under one part of the foot

Question 9

what is a TCC

Answer 9

total contact cast, which is the gold standard for forefoot ulceration and Charcot foot. This is forced offloading for 1-2 weeks at a time.

Question 10

how does TCC affect gait

Answer 10

decreased activity, stride length and cadence

Question 11

what is the disadvantages of TCC

Answer 11

need special training, hot and heavy and difficult to self-care

Question 12

what is proper shoe fit without an ulceration

Answer 12

• shape of the shoe should conform,
• you should have 3/8-1/2 inch space between the longest toe and end of shoe
• deep toe box (for toes to spread)
• not pointy or cramped toes
• adjustable aces or straps for a snug fit
• fit snugly around heel
• wear socks
• closed toes

Question 13

when do we avoid exercise, at what glucose levels

Answer 13

> 250 with ketosis and >300 without

Question 14

when do we want to hydrate and eat

Answer 14

before, about 17 ounces

eat: 2 hours before exercise, or exercise 1 hour after food intake

Question 15

what bout snacks

Answer 15

quick absorbing (fruit) every 30 minutes 
slow (breads, crackers, pasts) after exercise

Question 16

for type 2, how many days between bouts of exercise

Answer 16

no more than 2 days

Question 17

TF: it is no better to exercise at regularly and set times than random

Answer 17

false, we want regular and set times. (like around food and injection schedules)

Question 18

if glucose is <70…

Answer 18

no exercise

Question 19

do we want to exercise late at night and alone

Answer 19

no, may get a delayed hypoglycemia event during sleep

Question 20

can we use an injection sites over muscles that will be heavily used that day

Answer 20

no

Question 21

TF: its ok to do high intensity impact and head down exercises

Answer 21

false, we want low impact and resistance, and walking, stationary bike, swimming, rowing and UE exercise

Question 22

what is the exercise goal for pre-diabetics

Answer 22

lose 5-10% body weight and at least 150 minutes moderate exercise per week

Question 23

what is the focus of exercise

Answer 23

overall health and importance of regular exercise and FALL prevention

Question 24

with neuropathic injuries what precautions must we take with heat application

Answer 24

• faster insulin absorption from the injection site can lead to hypoglycemia
• more likely to burn (decrease blood flow and sensation)
• abnormal cardiac responses

Question 25

why must we be careful with cold application

Answer 25

slower absorption from injection site (hyperglycemia)

and cold tissue injury

Question 26

how is the treatment team a multi-disciplinary approach

Answer 26

PCP, Diabetes management, podiatrist, PT, orthotist, ortho surgeon, vascular surgeon