DIABETIC FOOT EXAM QUESTIONS AND ANSWERS 2024

Damage or disease affecting nerves which may impair sensation, movement, gland or organ function or other aspects of health, depending on nerve affected defines what? Neuropathy What is the most common neuropathy in the western world? Diabetic neuropathy About ____% of pts with DM will eventually develop some form of neuropathy 50% Diabetic neuropathy results in substantial morbidity due to... Recurrent LE infections, ulcers, amputations Risk of amputation is ______% 25 years after diagnosis 11% What are the characteristics of Class I subclinical diabetic neuropathy? - Neuro function tests ABNORMAL - No neuro symptoms - No clinically detectable neuro deficits on CN exam What are the characteristics of class II diabetic neuropathy? - Neuro function tests ABNORMAL - Neuro symptoms present - Clinically detectable symptoms indicating a diffuse or focal neuropathy What is the most common type of diabetic neuropathy? Distal symmetric sensorimotor polyneuropathy Describe Distal symmetric sensorimotor polyneuropathy Progressive loss of distal sensation correlating to loss of sensory axons - classic "stocking glove" sensory loss Describe Autonomic dysfunction neuropathy - Insidious onset - Diagnosis of exclusion - Can causes severe dysfunction in a single organ (hypotension, gastroparesis, enteropathy w/constipation/diarrhea) What is the most common upper peripheral mononeuritis? Median nerve at wrist Give an example of a lower peripheral mononeuritis Peroneal nerve neuropathies with compression at the fibula - FOOT DROP Focal onset of pain followed by weakness in the proximal leg that's associated with autonomic failure and weight loss should make you think... Diabetic Amyotrophy Describe the pathophysiology of diabetic neuropathy Healthy tissue —> capillary damage —> nerve damage and loss of sensation in extremities —> Injury due to loss of sensation —> Increased risk for infection, ulcers and gangrene What are the risk factors associated with peripheral neuropathy? - Duration and severity of hyperglycemia - Age - Glycemic variability - Dyslipidemia - HTN - Smoking What is the most common triad related to peripheral neuropathy? - Neuropathy - Deformity - Trauma What increases the risk for foot ulcers? - Previous amputation - Previous ulcer - Foot deformity - Visual impairment - Poor glycemic control - Smoking A pt with no LOPS, no PAD, and no deformity falls into what risk category? 0 A pt with LOPS +/- deformity falls into what risk category ? 1 A pt with PAD, plus or minus LOPS falls into what risk category? 2 A pt with Hx of ulcer or amputation falls into what risk category? 3 What are some preventative efforts for diabetic peripheral neuropathy? - Systematic foot exams at least yearly (every 3 mo or more if pt is risk 1-3) - Risk Assessment at office visits - Pt education on foot care - Strict glycemic control - Timely referrals How should you educate your pt on diabetic foot exams? To them to: - Visually examine both feet between toes - Keep feet dry by changing socks, dry feet after baths/exercise - Report any new lesions/color changes/swelling - Trim toe nails straight across and smooth them with a file - Recommend proper foot wear - Recommend stop smoking What should you cover in your ROS for diabetic pts? - Burning, tingling or pain in legs/feet - Leg or foot pain with activity or at rest - Changes in skin color or lesions - Loss of lower extremity sensation - Impaired vision What is an abnormal response to the vibration of the 128 Hz tuning fork on the great toe? When Pt loses vibratory sense yet examiner can still perceive it while holding tuning fork in place