Term
| Amputation risk is increased ___ times with diabetic foot ulcers. |
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Definition
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Term
| Why are the feet affected by diabetes? |
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Definition
| diabetes has harmful effects on microvasculature (eyes, kidneys, feet) |
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Term
| What factors play into DFU? |
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Definition
peripheral neuropathy
direct pressure
shear deformity
impaired immune system |
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Term
| What is a "high risk" zone? |
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Definition
| area of a neuropathic foot where increased pressure occurs |
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Term
| What is the "Q-tip test" in DFU? |
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Definition
| if you can advance a Q-tip into the wound and hit bone, the pt. probably has osteomyelitis |
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Term
| What things make a diabetic at high risk for developing DFU? What about low risk? |
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Definition
high risk--insensate, poor circulation, deformity
low risk--sensate, good circulation, no deformity |
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Term
| What are the risk factors for DFU? |
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Definition
peripheral neuropathy
peripheral vascular disease
deformities (bunions, hammertoe)
prior lower extremity amputation
prior DFU |
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Term
| What is involved in the diagnosis of DFU? |
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Definition
Q-tip test (check for osteomyelitis)
determine neuropathic vs. ischemic
vascular consult |
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Term
| Grade 1-5 DFU is based on what? |
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Definition
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Term
| Grade A-D DFU is based on what? |
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Definition
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Term
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Definition
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Term
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Definition
| no lesion or break in the skin |
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Term
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Definition
| deep ulcer that exposes tendons and joint (but not bone) |
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Term
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Definition
| exposed bone and/or abscess/osteomyelitis |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
| ischemia with partial foot gangrene |
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Term
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Definition
| ischemia with complete gangrene of entire foot |
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Term
| What grade of DFU can you touch bone and is usually diagnostic for osteomyelitis? |
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Definition
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Term
| _________ osteomyelitis is unusual. |
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Definition
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Term
| What signs of infection may be noted with osteomyelitis? |
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Definition
purulent drainage
elevated WBC
increased blood sugar or insulin demand |
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Term
| Radiographs in DFU can be helpful, but they must be correlated with _______ ______. |
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Definition
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Term
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Definition
| condition that affects diabetics (mostly) in which the bones become mushy, collapse, and then solidify again into a sharp point |
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Term
| What is in the differential for osteomyelitis? |
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Definition
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Term
| What 3 tests can be diagnostic for osteomyelitis? |
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Definition
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Term
| What are the components of treatment for DFU? |
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Definition
patient education
ulcer/wound care
nail care
offloading |
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Term
| What patient education should you give with DFU? |
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Definition
daily self exam
clean and dry
lanolin lotion
skin and nail care
socks
always wear shoes |
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Term
| How should patients with DFU take care of their nails? |
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Definition
trim transversely
rounded corners can lead to infected ingrown toenails |
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Term
| What may be needed in a non-compliant patient to help heal their ulcer? |
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Definition
total contact cast
disperses shear forces over a wider area |
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Term
| How long do most plantar ulcers take to heal? |
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Definition
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Term
| What can be used as a bridge from a total contact cast but has the same pressure-dissipating effect? |
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Definition
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Term
| What surgical technique, usually done at the time of amputation, can be done to decrease forefoot pressures? |
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Definition
| achilles tendon lenthening plus total contact casting |
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Term
| How long will a patient be in a total contact cast after having an achilles tendon lengthening procedure? |
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Definition
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Term
| Achilles tendon lengthening with a total contact cast decreases recurrence rate by ____ versus total contact casting alone. |
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Definition
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Term
| What are the indications for amputation in DFU? |
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Definition
osteomyelitis or soft-tissue infection that cannot be controlled
attempt to preserve function |
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Term
| What is the indication for a hallux amputation? |
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Definition
| uncontrolled great toe infection |
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Term
| What is the goal of hallux amputation? |
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Definition
| preserve flexor hallucis brevis insertion |
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Term
| What is the indication for a lesser toe amputation? |
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Definition
| uncontrolled isolated lesser toe infection |
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Term
| What may delay healing for DFU patients? |
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Definition
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Term
| What is the indication for a ray resection? |
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Definition
| isolated metatarsal osteomyelitis |
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Term
| What is the goal of transmetatarsal amputation? |
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Definition
| preserve the base of the 1st metatarsal (tibialis anterior insertion for best function) |
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Term
| What is the indication for a hindfoot amputation? |
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Definition
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Term
| What is an advantage of hindfoot amputation? |
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Definition
| allows some end weight bearing |
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Term
| What is a disadvantage of a hindfoot amputation? |
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Definition
| equinus from muscle imbalance |
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Term
| What are the indications for an ankle disarticulation (syme)? |
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Definition
uncontrolled osteomyelitis
less active patients |
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Term
| What is an advantage of ankle disarticulation (syme)? |
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Definition
| allows some end weight bearing |
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Term
| What is a disadvantage of ankle disarticulation (syme)? |
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Definition
| complex prosthetic fitting |
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Term
| What is the indication for a below knee amputation? |
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Definition
| uncontrolled foot infection |
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Term
| What are the advantages of a below knee amputation? |
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Definition
excellent function
rage of prostheses |
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