Nadia Quiz 3 Study 2 PDF

Intro to Neuropathic Ulcers Neuropathic Ulcers - Commonly called diabetic foot ulcer - 15-25% of patients with diabetes have this condition - Develop from - Neuropathy, high plantar pressures/stress, decreased skin oxygenation, diminished vascular perfusion - 60% w/ ulcer wi...

Intro to Neuropathic Ulcers Neuropathic Ulcers - Commonly called diabetic foot ulcer - 15-25% of patients with diabetes have this condition - Develop from - Neuropathy, high plantar pressures/stress, decreased skin oxygenation, diminished vascular perfusion - 60% w/ ulcer will have another in 3 years - Leading cause of non-traumatic lower limb amputations - 50% will have 2nd amputation in 3-5 years - Risk Factors - Neuropathy - Peripheral Vascular Disease - Pre-Ulcerative Skin - Hypertension - Sex/Age - Smoking - Charcot Joint - Diabetes, impaired visual acuity, chronic renal disease, uncontrolled hyperglycemia Classification & Assessment of NUs Wagner Classification System - wagner sounda - Assesses ulcer depth & presence of osteomyelitis or gangrene by using scale - Scoring - 0 (No open lesions, may have deformity or cellulitis) - 1 (Superficial Ulcer) - 2 (Deep Ulcer to tendon, bone, capsule) - 3 (Deep Ulcer w/ absess, osteomyelitis, joint sepsis - 4 (Localized gangrene) - 5 (Gangrene on entire foot) PT Tests/Measures > - - Semmes-Weinstein Monofilament Test - Gold standard for assessing protective sensation of LE neipers - Vibration Sensation Exam - Use tuning fork for those who are high risk for neuropathic ulcers PT Interventions - Patient Related Instructions - Requires eduation to increse control over the process - Includes role, foot inspections, specific coordination - Additional precuations Procedural Interventions - Goals is to offload ulcer & provide safe/effective gait - Want NWB using a scooter - PWB w/ assistive device is okay - Wheelchair might be necessary for some patients Therapeutic Exercise - Recommendations for Individuals w/ Diabetes - Aerobic - 3-7 days/wk, Mod-Vig, 150 min/week at mod, large muscle groups - Resistance - 2 nonconsecutive days/wk, mod-vig, 8-10 exercises (1-3 sets/10-15 reps), free weights/machines - Flexibility - 2-3 days/wk, to point of tightness, static 10-30 sec/2-4 reps, static/dynamic/PNF Physical Agents/Modalities - Can be effective in assisting in wound closure/pain relief - Types - Negative pressure wound therapy - Ultrasound - E-Stim - TCC - Recommended for Wagner grade 1-2 - Allows WB dispersed over larger area - Assists w/ edema management & protection from trauma - Contraindications - Osteomyelitis, gangrene, flucutating edema, active infections, ABI