tailieunhanh - Diabeticcpg small 2 (Part 2)

Figure 4 Diagnostic imaging plays an important role in the evaluation of diabetic foot infections. (A) This patient presented with a deep foul-smelling necrotic ulcer of the heel that had been present for more than 1 month. (B) In the past, a technetium bone scan typically would be performed, but the imaging is nonspecific and many false positive results interpretative as osteomyelitis were seen. (C) White blood cell tagged imaging with indium or technetium is a more reliable technique for detecting the presence of infection. . | Table 3 Lower Extremity Diabetic Foot Exam Vascular Examination Palpation of pulses Common femoral popliteal Dorsalis pedis posterior tibial Handheld Doppler examination Skin limb color changes Cyanosis erythema Elevation pallor dependent rubor Presence of edema Temperature gradient Ipsilateral and contralateral extremity Dermal thermometry Integementary changes Skin atrophy - thin smooth parchment-like skin Abnormal wrinkling Absence of hair growth Onychodystrophy Previous hospitalizations surgery Neurologic Examination Vibration perception Tuning fork 128 cps Measurement of vibration perception threshold biothesiometer Light pressure Semmes-Weinstein 10 gram monofilament Light touch cotton wool Two point discrimination Pain pinprick sterile needle Temperature perception hot and cold Deep tendon reflexes patella Achilles Clonus testing Babinski test Romberg test Footwear Examination Type of shoe athletic oxford comfort etc. Fit Depth of toe box Shoewear patterns of wear Lining wear Foreign bodies Insoles orthoses Dermatologic Examination Skin appearance - Color texture turgor quality - Dry skin Calluses - Discoloration subcallus hemorrhage Fissures especially posterior heels Nail appearance - Onychomycosis dystrophic gryphotic -Atrophy or hypertrophy - Paronychia Hair growth Ulceration gangrene infection Note location size depth infection status etc. Interdigital lesions Tinea pedis Markers of diabetes - Shin spots - diabetic dermopathy - Necrobiosis lipoidica diabeticorum - Bullosum diabeticorum - Granuloma annulare - Acanthosis nigricans Musculoskeletal Examination Biomechanical abnormalities Structural deformities - Hammertoe bunion tailor s bunion - Hallux limitus rigidus - Flat or high-arched feet - Charcot deformities - Postsurglcal deformities amputations Prior amputation Limited joint mobility Tendo-Achilles contractures equinus Gait evaluation Muscle group strength testing - passive and active non-weightbearing and weightbearing - Foot drop - Atrophy - .