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For the person with arterial or diabetic ulcers, especially on the plantar surface, _______ is necessary. If uninfected, a ______ ______ _____ or ________ _______ ______ can be used while the ulcer continues to heal.
- 1. offloading
- 2. total contact cast
- 3. posterior walking splint
-Shoe modification can include: custom molded insert with cutout, rocker bottom, T-shaped steel shank.
- True or False: Medicare part B will pay for Diabetic shoes, for diabetic patients with peripheral neuropathy.
True (so will some private insurances)
__-scan: expensive machine used to measure ambulating plantar pressures. HIgh pressure zones would likely correspond with observed areas of foot deformity or callous formation.
True or False: In patients using walking casts, healing time has been found to be faster in midfoot and rearfoot ulcers than forefoot ulcers.
False: healing is faster in forefoot than midfoot and rearfoot
_____ _____ _____: sequential compression devices for prophylaxis of DVT. Evidence does not support use for Chronic Venous Insufficiency, and use in Lymphedema is controversial
Intermittent Pneumatic Compression
Intermittent Pneumatic Compression: 4 contraindications
ABI<.8, infection, decompensated CHF, hypertension
(Tip from Dr. Wingert: pressure in the venous system is 25-35mmhg, but in the lymphatic only 10-12mmhg. Therefore, higher pressures will risk collapsing the lymphatic channels.)
What does the evidence say about the use of IPC?
may increase healing compared with no compression, but it is not clear whether it increases healing when added to treatment with bandages or in conjunction with bandages
Describe Daily inspection for persons who must have pressure relief to prevent plantar ulcers?
- -use a mirror
- -check for callous, trophic changes (dry,cracked), warmth, swelling, discoloration, lesion
Instructions for proper shoe fit:
-shoe should conform to the shape of your _____.
-there should be at least a 1/2 of a ______ width between the end of the shoe and your _____ toe while you are standing.
-the ___ ___ should be deep and wide enough for you to spread your toes and raise your toes.
-the shoe should fit ____ around your heel.
-the shoe should have _____ or _____ that adjust for a snug fit over the top of your foot.
- -foot haha
- -thumb's (approximately the size of Cole's....)/longest toe
- -toe box
- -laces or straps
Examining of the shoe off the person's foot:
-The shoe _____ (back part of the shoe surrounding the rearfoot) should offer firm support and stability, but should also be topped by a soft collar.
-Place the shoe on a flat surface. There should be a slight rise of the ____ over the ____. (helps advance the tibia in midstance).
-_____-type opening with shoestrings or velcro closings are better than the __ type opening. _______ allows more "give" across the dorsum of the foot accomodating changes in foot circumference.
-Check for internal ____ that might rub or cause skin problems.
-Check for bulges in the outer shoe material. ARe there calluses on the person's foot that correspond to these ____.
-Check the wear patterns on the ____ and ____.
-The crease in the shoe across top of the forefoot should be a straight ______ line. If the crease is on a _____, it means the shoes are too long or short.
- -sole over the toes
- -heel and sole
E-stim physiological effects:
-reduces ____ load
-promotes _____ tissues.
-decreases _____ and _____.
-improves blood _____.
- -inflammation and edema
- -blood flow
Will Medicare pay for dressing changes alone?
no, must document debridement to be reimbursed
_____ ____: sponge, suction tube, and transparent adhesive film are incontact with the wound and remain in place continuously (thus could also be categorized as a wound dressing). There is solid research on promoting granulation tissue and approximating wound margins.
______ _____: effective as a bactericide for a wound that cultures positive for MRSA. Can be used to stimulate healing via mild inflammation, stimulating cell proliferation, and promoting granulation tissue.
Monochoromatic infrared photo energy (MIRE) efficacy is still undetermined, but it is becoing increasingly used in the clinic. The most recent well done study shows no difference compared to sham. Therapist who use it are probably billing it as thermotherapy, which is the only FDA approved use.
Answer: it wasn't a question, but a statement; how in the world was I supposed to ask a question about that?
_____ _____ chamber: procedure performed bya specially trained nurses or respiratory therapists, not PT. Its use is controversial, and evidence is still preliminary. Method: patient breathes pure oxygent at twice the normal atmospheric pressure for 90-120 minutes.
Hyperbaric Oxygen Chamber
_______ ______: patient will complain of calf pain at a predictable walking distance. This is one of the few times when we tell our patients "no pain, no gain." They must push through the pain and walk further the next time. They can rest: sitting with legs in dependent position. Then repeat. Physiologically when they provide this overload stimulus, collateral sprouting of arterioles can occur, and muscle myoglobin can become more efficient.