Neuropathic Ulcers

ischemia

diabetic wounds are a result of _____ that results in damage and inflammation to the nerve and its sheath

neuropathy ischemia structural changes

_____+____+____ ____ = abnormal pressure points and repeated trauma

elasticity strength

a lack of insulin in DM can lead to reduced collagen synthesis resulting in decreased skin _____ and decreased tensile ____ of the skin - increased likelihood of ulcers and decreased healing

distally

RF for diabetic wounds; a loss of sensation _____; leaves patients at higher risk of injury due to lack of sensation

blood flow

RF for diabetic wounds; decreased ____ ____ - inadequate oxygenation and tissue perfusion = damage of tissues and impaired wound healing (lack of nutrients)

plantarflexors

neuropathy causes structural deformities of the feet where ____ are stronger than dorsiflexors; results in contracture that alters standing posture, foot pressures, and increased metatarsal/toe pressures and deformities

callus

structural deformities and altered weight distribution/increased pressures results in ____ formation

dry callus sweat

Impaired ANS in DM; leads to ____ and cracked skin, ____ formation, and lack of _____

keratin

Impaired ANS in DM; excessive ____ buildup leads to thickening of the skin

immune system

DM lead to decreased ____ _____; chronic inflammation, hyperglycemia impairs WBC/neutrophil function

neuropathic wounds

round and punched out wounds with little to no drainage, callus rim, dry/cracked skin, clawing of toes

plantar

the _____ surface of the foot is the most common location for diabetic wounds followed by great toe, 1st med head, dorsum of digits, plantar surface of other toes, 5th met head

Charcot foot

progressive condition common in patients with DM as a result of neuropathy; characterized by joint dislocations, pathologic fractures, and deformities - edema, erythema, skin temp differences, ulceration of midfoot

pain

patients lack ____ with charcot foot (neuropathy)

cellulitis

charcot foot can acutely mimic ____ or DVT (warmth, erythema, swelling)

first

With charcot foot, the arch will collapse and the ____ MT rotates due to articulation with medial cuneiform

neuropathy

the primary RF for charcot foot is peripheral _____

charcot foot

shoewear such as total contact casting, CROW boot or charcot shoe are commonly used to redistribute pressure and prevent deformity for what condition

total contact casting (TCC)

treatment for charcot foot that is replaced weekly, protects from trauma, reduces edema, offloads forefoot and midfoot, and it NOT removable

Disadvantages = heavy and hot - difficult bathing, walking, sleeping, fall risk

**still considered GOLD STANDARD

Wagner grading scale

grading scale for diabetic wounds; grade 0-5 **once given a grade it NEVER gets a lesser grade (can't downgrade, can upgrade)

0

Wagner grade ___ diabetic wounds; no open lesions, may have deformities or cellulitis, damage to foot but skin is intact, may have pre-ulcer lesions, bone deformities

Treatment = protection

1

Wagner grade ___ diabetic wound; superficial or partial thickness ulcer, does NOT involve subcutaneous tissue

Treatment = local wound care, protect from maceration, foot protection

2

Wagner grade ___ diabetic wound; full thickness wound with subcutaneous involvement. Deep ulcer to tendon, capsule, or bone

Treatment = local wound care, manage edema, protect from maceration, wound protection

3

Wagner grade ___ diabetic wound; infection - abscess, osteomyelitis, joint sepsis

Treatment: refer to orthopedic surgery

Osteomyelitis

infection, specifically infection in the bone; look for prolonged ulcer, recurrent ulcer in the same spot, nonhealing ulcer despite aggressive treatment or worsening wound

4

Wagner grade ___ diabetic wound; localized gangrene typically of the FOREFOOT

5

Wagner grade ____ diabetic wound; gangrene of most of the foot

wet gangrene

necrosis of tissue followed by destruction caused by excessive moisture

ABI

____ is NOT reliable in DM