Presentation is loading. Please wait.

Presentation is loading. Please wait.

Amy Splitter, DPM ACMC Division Chief, Division of Podiatry Assistant Professor, California School of Podiatric Medicine at Samuel Merritt University.

Similar presentations


Presentation on theme: "Amy Splitter, DPM ACMC Division Chief, Division of Podiatry Assistant Professor, California School of Podiatric Medicine at Samuel Merritt University."— Presentation transcript:

1 Amy Splitter, DPM ACMC Division Chief, Division of Podiatry Assistant Professor, California School of Podiatric Medicine at Samuel Merritt University

2 Four Basic Elements to lower extremity foot exam Vascular Neurological Dermatological Musculoskeletal

3

4 How far can you walk? Major Risk Factors Tobacco Diabetes mellitus HTN Cardiac disease CVA Family history

5 Skin color, temp Skin thickness and texture Digital hair Toenail condition

6 6 Dorsalis pedis (DP) Posterior tibial (PT) Perforating peroneal (PP)

7 7 EHL Tendon Palpate here

8

9 Medial malleolus

10

11

12

13

14

15 Absent, Diminished, Palpable, Bounding vs. 1+, 2+, 3+, 4+

16 The time it takes to completely fill the area of pallor Normal:< 3 seconds PAD:> 10 sec

17 1. Place foot at heart level

18 2. Squeeze blood from the hallux

19

20 3. Observe time for blood return

21 Common Errors Digit below heart level Residual venous blood

22

23

24 Apply acoustic gel

25 Normal PT Normal hallux artery Abnormal DP Vein

26

27

28 Ankle pressure/Brachial pressure Normal 1.0 – 1.2 Grossly abnormal <0.5

29 Does not measure collateral flow Cannot confirm flow distal to probe Interpret results in diabetics with caution

30

31 DM neuropathy IM neuroma Tarsal tunnel syndrome Nerve impingement CVA

32 PMH, ROS: Any potential causes of neuropathy? Diabetes mellitus Prior surgery Nerve injury Medications Lower back problems CVA

33 Personal History: Any potential causes of neuropathy? EtOH abuse Occupational exposures Chemotherapy HIV Elderly Many different causes

34 Local Regional Sensory Autonomic Motor-UMN vs. LMN

35 Upper Motor Neuron Affects groups of muscles Only slight atrophy Spasticity with hyperreflexia No fasiculations Normal nerve conduction studies Lower Motor Neuron Affects individual muscles Atrophy Flaccidity, hypotonia and hyporeflexia Fasiculations Abnormal nerve conduction studies

36 Sensory examination Motor examination Sensory-motor examination Gait

37 Compare right to left Compare distal to proximal Nerve injuries can be subtle

38 Depends on the subjective response of the patient Focus your testing based on the HPI

39 Safety pin Semmes-Weinstein 10 gm monofilament Q-tip 128 Hz tuning fork Paper clip

40 Vibratory Proprioception Pain Temperature Pressure (protective sensation) 2 point discrimination Light touch Percussion

41 For each sensory test, you should consider the following: Which nerve is being tested? Which dermatome is being tested? What spinal pathway is being used?

42

43 Tests pressure sensation Uses: R/o LOPS Map out sensory deficit

44 Prerequisites Patient understanding Non-callused skin

45 Prerequisites Patient understanding Non-callused skin

46 Demonstrate that this wont hurt

47 Show the patient what to expect

48 Start distally

49 Bend the filament, then release

50

51 Result interpretation No LOPS if patient can feel distal medial and lateral plantar nerves. LOPS is present if patient cannot feel distally

52 128Hz tuning fork Uses: Check for early signs of neuropathy

53 53 Vibratory technique

54 Result interpretation Normal: Pt can state when the vibration stops (within 5 seconds) Abnormal: Vibration continues for 10 seconds after pt states the vibration has ended.

55 Paresthesia :An abnormal sensation Anesthesia :Complete loss of sensation Hypoesthesia :Diminished sensation (aka hypesthesia) Allodynia : Pain from a non-painful stimulus Hyperpathia :Pain out of proportion to the stimulus. Pain continues post-stimulation.

56

57 Deep Tendon Reflexes Deep Tendon Reflexes Achilles Patellar Superficial Reflexes Superficial Reflexes Babinski Chaddock (lateral foot) Oppenheim (shin) Gordons (gastrocnemius) Stranskys (abduct 5 th toe)

58 DTR Scoring 0No response 1+Diminished 2+Normal 3+Increased 4+Hyperactive

59

60 Incorrect Technique

61

62

63 Inspection Palpation

64 Temperature Turgor Texture Edema

65 Inspection Skin color Hyperkeratoses Hydration Scaling Webspaces Toenails

66

67 67

68

69

70

71

72

73

74

75 Heloma durum HD Excrescence Hyperkeratotic papule Heloma molle

76 Keratoma Intractable Plantar Keratosis (IPK) Tyloma

77

78

79

80

81 81

82

83

84 84

85

86

87

88

89 89

90

91

92

93

94 Color Number Size Grouping (discrete, confluent, scattered…) Location Texture (smooth, waxy, weeping, lichenified) Symptoms Shape

95 95

96 Primary lesions Arise from a change in normal skin Secondary lesions Arise from changes to pre- existing pathology

97

98

99

100

101

102

103 103

104

105

106

107 A = Asymmetry B = Border C = Color D = Diameter E = Enlarging

108

109

110

111 Inspection Palpation Range of motion Motor strength Muscle tone WB and NWB

112

113 Bony prominences Deformity Symmetry Wasting Fasiculations

114

115

116

117

118

119

120

121

122

123 Tonus (tone): The resistance felt when a limb is passively moved. Tone can be hyper or hypo.

124 For each muscle being tested, you should consider the following: Which nerve innervates the muscle? What nerve root is associated with the muscle movement?

125

126

127 5 Full motor power 4 Active movement against some resistance 3 Weak contraction against gravity 2 Active movement w/o gravity 1 minimal contraction w/o joint movement 0 no contraction

128

129

130

131

132

133

134 Appropriate referrals to the podiatry department Handout for diabetic exam/referral What is a podiatric emergency? Annual diabetic exams Determination of high risk versus low risk patients for ulceration and amputation

135 Elective surgery: bunion, hammertoe, arthroscopy, soft tissue mass excision Deformity correction: pes cavus, pes planus Trauma: Fracture care Digits Metatarsals Ankle Talus Calcaneus

136 Urgent and prophylactic limb salvage surgery Small procedures in clinic: nail avulsions, skin biopsy, injections

137


Download ppt "Amy Splitter, DPM ACMC Division Chief, Division of Podiatry Assistant Professor, California School of Podiatric Medicine at Samuel Merritt University."

Similar presentations


Ads by Google