28 ABI Interpretation Ankle pressure/Brachial pressure Normal 1.0 – 1.2 Grossly abnormal <0.5
29 ABI Pitfalls Does not measure collateral flow Cannot confirm flow distal to probeInterpret results in diabetics with cautionOther diseases that may also have calcification deposition include: DM, chronic kidney disease, systemic lupus, chronic inflammatory conditions.
31 Common LE neurological problems DM neuropathyIM neuromaTarsal tunnel syndromeNerve impingementCVA
32 Neurological workup PMH, ROS: Any potential causes of neuropathy? Diabetes mellitusPrior surgeryNerve injuryMedicationsLower back problemsCVA
33 Neurological workupPersonal History: Any potential causes of neuropathy?EtOH abuseOccupational exposuresChemotherapyHIVElderlyMany different causesAlso B12 deficiency.
34 Where’s the neurological problem? LocalRegionalSensoryAutonomicMotor-UMN vs. LMN
35 UMN vs. LMN Upper Motor Neuron Lower Motor Neuron Affects groups of musclesOnly slight atrophySpasticity with hyperreflexiaNo fasiculationsNormal nerve conduction studiesLower Motor NeuronAffects individual musclesAtrophyFlaccidity, hypotonia and hyporeflexiaFasiculationsAbnormal nerve conduction studies
54 Sensory Examination : Vibratory Result interpretationNormal: Pt can state when the vibration stops (within 5 seconds)Abnormal: Vibration continues for 10 seconds after pt states the vibration has ended.
55 Sensory Examination: Vocabulary Paresthesia: An abnormal sensationAnesthesia: Complete loss of sensationHypoesthesia: Diminished sensation (aka hypesthesia)Allodynia: Pain from a non-painful stimulusHyperpathia: Pain out of proportion to the stimulus. Pain continues post-stimulation.
127 Motor Testing: Strength 5 Full motor power4 Active movement against some resistance3 Weak contraction against gravity2 Active movement w/o gravity1 minimal contraction w/o joint movement0 no contraction
134 Discussion Appropriate referrals to the podiatry department Handout for diabetic exam/referralWhat is a podiatric emergency?Annual diabetic examsDetermination of high risk versus low risk patients for ulceration and amputation
135 Podiatric ServiceElective surgery: bunion, hammertoe, arthroscopy, soft tissue mass excisionDeformity correction: pes cavus, pes planusTrauma: Fracture careDigitsMetatarsalsAnkleTalusCalcaneus
136 Podiatric Service Urgent and prophylactic limb salvage surgery Small procedures in clinic: nail avulsions, skin biopsy, injections