PRESENT Podiatry Online CME & Conferences 8/26/18, 9)48 PM

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Conservative Surgeries for the Diabetic Foot - What Works and What Doesn't Wo…

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PRESENT Podiatry Online CME & Conferences 8/26/18, 9)48 PM

1. * A 59-year-old male presents to the clinic complaining of a draining ulceration located on plantar
aspect of the right first metatarsal head. He states that the ulceration has been there for 4 months
and has progressively increased in size. The patient states that the drainage is purulent in nature
and is malodorous. The patient denies any pedal pain at this time but attests to intermittent calf
spasms at night.

ROS: Negative in all 12 systems.

PMHx: DM2, HTN

FH: Mother DM2, Father DM2, CAD, HTN, PAD
PSH: Laparoscopic Cholecystectomy
Medications: Metformin, Insulin, Atenolol
1. Allergies: NKDA
A 59-year-old male presents to the clinic complaining of a draining ulceration located on plantar
Hospitalization: None
aspect of the right first metatarsal head. He states that the ulceration has been there for 4 months
Social History: Denies tobacco, alcohol, and drugs. Patient lives alone and currently works part
and has progressively increased in size. The patient states that the drainage is purulent in nature
time as a cashier.
and is malodorous. The patient denies any pedal pain at this time but attests to intermittent calf
spasms at night.
Physical examination:
*Gen: WD/WN, obese, NAD
ROS: Negative in all 12 systems.
- Vascular: DP/PT ¼ bilaterally, moderate non-pitting edema localized to the first great toe on the
PMHx: DM2, HTN
right foot, CFT < 3 seconds x 10 toes.
FH: Mother DM2, Father DM2, CAD, HTN, PAD
- Neurological: Protective sensation 2/10 via SWMF, vibratory sensation absent, light touch
PSH: Laparoscopic Cholecystectomy
sensation intact
Medications: Metformin, Insulin, Atenolol
- Musculoskeletal: Pes planus foot type, abducted hallux bilaterally, RCSP valgus
Allergies: NKDA
- Dermatological: Calluses located sub 2nd/3rd metatarsal heads bilaterally, ulceration sub-1st
Hospitalization: None
metatarsal head on the right foot measuring approximately 3.3 x 0.9 x 0.4 cm, probes to bone,
Social History: Denies tobacco, alcohol, and drugs. Patient lives alone and currently works part
purulent drainage, peri-wound erythema noted
time as a cashier.
Imaging: Right foot 3 views X-ray reveals fragmentation of the right 1st metatarsal head as well as
Physical examination:
the base of the 1st proximal phalanx.
Gen: WD/WN, obese, NAD
Which of the following scenarios reflects when conservative surgeries to treat diabetic foot
- Vascular: DP/PT ¼ bilaterally, moderate non-pitting edema localized to the first great toe on the
infections do not work?
right foot, CFT < 3 seconds x 10 toes.
- Neurological: Protective sensation 2/10 via SWMF, vibratory sensation absent, light touch
A. A. Performing foot-sparing surgery in cases in which the entire limb has loss of protective
sensation intact
sensation
- Musculoskeletal: Pes planus foot type, abducted hallux bilaterally, RCSP valgus
- Dermatological: Calluses located sub 2nd/3rd metatarsal heads bilaterally, ulceration sub-1st
metatarsal head onfoot-sparing
B. Performing the right foot measuring
surgery approximately
in cases 3.3 x 0.9has
where limb ischemia x 0.4
notcm, probes
been to bone,
adequately
purulent drainage, peri-wound erythema noted
addresse

Imaging: Right foot 3 views X-ray reveals fragmentation of the right 1st metatarsal head as well as
the base of the 1st proximal phalanx.

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Which of the following scenarios reflects when conservative surgeries to treat diabetic foot
infections do not work?
PRESENT Podiatry Online CME & Conferences 8/26/18, 9)48 PM

C. Performing foot-sparing surgery in cases where the patient has multiple wounds on the foot
None of the above

D. None of the above

2. * According to Piaggesi et al, which of the following led to an increased healing rate and decreased
recurrence of ulceration?

A. Conservative surgical approach

C. Performing foot-sparing surgery in cases where the patient has multiple wounds on the foot
None of the above
B. Debridement with foot orthotics

D.
C. None of the above
Strict off-loading

2. D. Ankle-Foot orthosis
According to Piaggesi et al, which of the following led to an increased healing rate and decreased
recurrence of ulceration?

3. * In aA.study done by Murdoch

Conservative et al of 90 patients undergoing amputation of the big toe, what is the
surgical approach
percentage of patients that required a second amputation other than a below the knee amputation?
* B. Debridement with foot orthotics
A. 10%

C. Strict off-loading
B. 20%

D.
C. Ankle-Foot
40% orthosis

3. D. 60%
In a study done by Murdoch et al of 90 patients undergoing amputation of the big toe, what is the
percentage of patients that required a second amputation other than a below the knee amputation?

4. * Which of the following types of amputations has the highest incidence of re-ulceration due to
A. 10%
transfer lesions?
* B. 20% metatarsal head resections
A. Several

C. 40%
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D. 60%
PRESENT Podiatry Online CME & Conferences 8/26/18, 9)48 PM

B. Transmetatarsal amputation

C. Second metatarsal amputation

D. First metatarsal amputation

5. * True or False: Flexor tenotomies and toe arthroplasties may work in treatment of diabetic plantar
ulcerations, but well-designed research is still needed

B. Transmetatarsal amputation
A. True

C. Second metatarsal amputation

B. False

D. First metatarsal amputation

*5-. Required
True or False: Flexor tenotomies and toe arthroplasties may work in treatment of diabetic plantar
ulcerations, but well-designed research is still needed
Submit
A. True

* B. False

Submit

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