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:
Amy Splitter, DPM ACMC Division Chief, Division of Podiatry Assistant Professor, California School of Podiatric Medicine at Samuel Merritt University
Four Basic Elements to lower extremity foot exam Vascular Neurological Dermatological Musculoskeletal
How far can you walk? Major Risk Factors Tobacco Diabetes mellitus HTN Cardiac disease CVA Family history
Skin color, temp Skin thickness and texture Digital hair Toenail condition
PMH, ROS: Any potential causes of neuropathy? Diabetes mellitus Prior surgery Nerve injury Medications Lower back problems CVA
Personal History: Any potential causes of neuropathy? EtOH abuse Occupational exposures Chemotherapy HIV Elderly Many different causes
Local Regional Sensory Autonomic Motor-UMN vs. LMN
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
Sensory examination Motor examination Sensory-motor examination Gait
Compare right to left Compare distal to proximal Nerve injuries can be subtle
Depends on the subjective response of the patient Focus your testing based on the HPI
Result interpretation No LOPS if patient can feel distal medial and lateral plantar nerves. LOPS is present if patient cannot feel distally
128Hz tuning fork Uses: Check for early signs of neuropathy
53 Vibratory technique
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.
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.
Tonus (tone): The resistance felt when a limb is passively moved. Tone can be hyper or hypo.
For each muscle being tested, you should consider the following: Which nerve innervates the muscle? What nerve root is associated with the muscle movement?
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
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
Elective surgery: bunion, hammertoe, arthroscopy, soft tissue mass excision Deformity correction: pes cavus, pes planus Trauma: Fracture care Digits Metatarsals Ankle Talus Calcaneus
Urgent and prophylactic limb salvage surgery Small procedures in clinic: nail avulsions, skin biopsy, injections