Professional Documents
Culture Documents
Neuropathic Ulcers For Students
Neuropathic Ulcers For Students
Neuropathic Ulcers For Students
Assessment of Circulation
Pulses and capillary refill
Doppler Ultrasound or ankle-brachial index
Classifying wounds
the 5PT method
1.
2.
3.
4.
5.
6.
Pain
Position
(Wound) Presentation
Periwound and structural changes
Pulses
Temperature
Absent or minimal
Position
Wound presentation
Normal
Temperature
Normal or increased
Neuropathic ulcer
Better prognosis
Smaller, superficial (Wagner grade 1 or 2)
Decrease in size within 4 weeks of treatment
Physician
Surgeon
Podiatrist
Nutritionist/Diabetic educator
Endocrinologist
Orthotist
Psychological counselor
Social worker
Patient instructions
Offload ulcer
Callus: pared flush with epithelial surface
Petroleum-based moisturizer daily
Toe spacers
Adjunct modalities
Negative pressure wound therapy
Ultrasound
Electrical stimulation
Permanent Footwear
Fit
~ longer than the longest toe,
with snug heel fit
Last should match shape of foot
Extra-depth toe box
Characteristics of footwear
Characteristics
Ulcer grade
1,2
1,2,3,4
1,2,3,4
Removable
No
Yes
Yes
Shear forces
----
--
Rocker-bottom
Yes
Yes
Yes
Enclosed toes
Yes
Yes
Yes
Weight
Moderate
Heavy
Light
Cosmesis
Fair
Fair
Good
Aerobic exercise
Glycemic control
Manual therapy
Footwear modifications
Medical interventions
Glycemic control
Pharmacologic management
Paresthesias
Concomitant arterial insufficiency
Antibiotic therapy
Cultures average four to five microbes
Broad-spectrum antibiotic: topically, orally, or
intravenously
Radiological Assessment
X-rays and bone scan (gold standard)
Surgical interventions
Debridement
Large amounts of necrotic tissue or osteomyelitis
Joint arthroplasty
Tendon lengthening
Stabilization of Charcot deformities
Reduction of abnormal biomechanics
Revascularization surgery
Amputation
Gangrenous, and grade 4 or 5 wounds