Lower Extremity and Foot Assessment and Risk Determination Helen Hodges, RN, PhD Georgia Baptist College of Nursing Mercer University Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Copyright 2005 H Hodges RN PhD Do not copy without permission Did you know? 3 out of 4 Americans experience serious foot problems in their lifetime. Your feet mirror your general health…foot ailments may be the first sign of more serious medical problems. Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Copyright 2005 H Hodges RN PhD Do not copy without permission And yet…….. …there are currently more websites on the Internet having to do with foot fetish than foot health???? http://www.Foot.com Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Basic Foot Care Scope of Practice Low Risk: No risk assessed. Provide hygiene, comfort, patient education. High Risk: long, thick or crumbled toenails, early protective impairment, skin involvement, edema, no infections or open lesions. Referral: (NP, MD, Wound Specialist,) for open lesions, complications. Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Copyright 2005 H Hodges RN PhD Do not copy without permission Essential Tools Monofilament (5.07/10Gm) 6.10 (optional) Tuning Fork (optional) Magnifying glass Traceable paper Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Assessment Circulation (pulses, temp, color, edema) Dorsalis Pedis Posterior Tibial Skin: color, texture, hair growth dorsalis pedis Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Copyright 2005 H Hodges RN PhD Do not copy without permission Neuropathy: Sensory Sensory: (Protection & Pain) Loss of (or abnormal) sensation Hx: Numbness, tingling, pain. *drop in shoe size…a red flag for loss of sensation Assessment: Monofilament 5.07 (10Gm) Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Protective Sensation Monofilament Placement **2 points toes **1-3-5 metatarsal heads (plantar) Heel Arch Ankle Top *Find line of change in sensation, if any to document changes Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Copyright 2005 H Hodges RN PhD Do not copy without permission Semmes-Weinstein (5.07 monofilament) Press nylon probe against the skin until it buckles. Significant impairment of protective sensation is present if the patient does not detect its presence (4 of 10 sites) Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Copyright 2005 H Hodges RN PhD Do not copy without permission Vibratory Sensation A 128-cycle tuning fork is touched over a bony prominence to assess sensations of the patient. Normal sensation is to feel the vibration. Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Neuropathy: Autonomic Autonomic: damage to nerves that cause sweating (and vasoconstriction. Assessment: Skin dry, flaky, cracked (fissures); Painless hyperemia, swelling, warm to touch, fallen arch, bounding pulse. Charcot’s foot Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Copyright 2005 H Hodges RN PhD Do not copy without permission Neuropathy: Motor Assessment: Foot and toe deformities, curled toes, “claw” flexion, overlapping. Note: atrophy of thigh & loss of knee reflex as red flag Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Copyright 2005 H Hodges RN PhD Do not copy without permission Nail Changes Caused by aging, chronic pressure from ill fitting shoes, DM, trauma, and/or fungus Thickening (hypertrophy) Crumbled nail fragments (fungus) onychomycosis Infection Distorted shape Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Onychomycosis (fungus) Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Copyright 2005 H Hodges RN PhD Do not copy without permission Onychomycosis + .... + cellulitis + cellulitis + Ram’s Horn +pseudomonas + Diabetes + early gangrene + HIV/AIDS Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Great Toe Onychomycosis and Ram’s Horn Nail Related Pressure Point Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

The ‘C’ Nail and Pressure Points Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Ingrown Toenail (infected) Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Copyright 2005 H Hodges RN PhD Do not copy without permission Skin Changes Callus: Common Metatarsal Head Locations (See also Fissure, Cellulitis) Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

**Altered Pressure Points Calluses **Altered Pressure Points Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Skeletal Changes Hammer Toe & resulting pressure points (Corn) Bunion Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Copyright 2005 H Hodges RN PhD Do not copy without permission Common Pressure Points with Skeletal Changes: Corn Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Copyright 2005 H Hodges RN PhD Do not copy without permission 2nd Metatarsal Head Callus Padding Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Assessment & level of risk? Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

And the answer is..... Poorly trimmed Charcot’s Foot Not fungus; polish remover Tattoo Cellulitis & gangrene Not fungus; nail neglect; distortion Ram’s Horn Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Interventions indicated.... Poorly trimmed Charcot’s Foot Not fungus; polish remover Cellulitis & gangrene Not fungus; nail neglect; distortion Ram’s Horn Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

TEACHING POINTS for Seniors and those at high risk *Wide toe boxes *Heels of shoes should fit snug and not slip Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

TEACHING POINTS for Seniors and those at high risk *Cotton socks *Change shoes and socks to air out every day *No constricting elastic/nylon hose Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

TEACHING POINTS for Seniors and those at high risk No medicated corn pads Fungus: Vicks VapoRub, Tea Tree Oil, Listerine, garlic Fungus: Soaks (8oz water, 1oz cider vinegar, 2 tsp bleach) Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

TEACHING POINTS for high risk Do not go barefoot Check feet everyday Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Copyright 2005 H Hodges RN PhD Do not copy without permission The End Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Copyright 2005 H Hodges RN PhD Do not copy without permission Questions????? Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission

Copyright 2005 H Hodges RN PhD Do not copy without permission Pix Copyright 2005 H Hodges RN PhD Do not copy without permission Atlanta Foot Care Coalition, 2005 (HH) Do not copy without permission