the insensate foot

7/30/2019 The Insensate Foot

1/23

2, 12 # 15


2/23

Introduction

Absent or impaired sensation.Reduced or lack of protective sensationin the foot.

Ulcer can develop over time.

2, 12 # 15


3/23

Ulceration

is not typically caused by a single injuryor ischemic episode, but rather evolvesas a slow change in the tissues resulting

from succession of moderate mechanicalstresses.

2, 12 # 15


4/23

Mechanisms for TissueDamage

High localized pressureProlong and sustained low pressure

Application of constant repetitions ofmoderate pressure

2, 12 # 15


5/23

Stages of Tissue Damage

1. Callus

2. Inflammation3. Ulcer

4. Infection

5. Abscess

6. Gangrene

2, 12 # 15


6/23

Callus Ulcer Abscess Gangrene

2, 12 # 15


7/23

PREVENT THE FIRST ULCER IS VERYIMPORTANT!

2, 12 # 15


8/23

Wagner Classification ofDiabetic Foot Ulcers

2, 12 # 15


9/23

Complications of InsensateFoot

Risk of foot injuryUlceration of the plantar surface of the

foot

Destruction of mid-foot leading toCharcot foot

2, 12 # 15


10/232, 12 # 15


11/23

Objectives

Reduce Pressure

Reduce Shear

Unload

2, 12 # 15


12/23

Orthotic Consideration

Total Contact Design

Relief

Removable walking boot with a custom

foot orthosisUse of patella tendon bearing

2, 12 # 15


13/23

Total Contact Casting

Plaster (or fiberglass) ismolded to relieve

pressure on the ulcer.

2, 12 # 15


14/232, 12 # 15


15/23

Charcot Foot

Also known asCharcot Joint

Charcot Arthropathy

Rocker Bottom Foot

2, 12 # 15


16/23

Charcot Foot

A common complicationof diabetes withneuropathy

Very disabling. Early

diagnosis and treatmentvitally important

2, 12 # 15


17/23

What causes a CharcotsFoot?Usually occurs in people whose sense of pain islost or impaired.

Muscles lose their ability to support the footcorrectly.

Minor trauma (e.g., sprains, stress fracture)goes undetected and not treated

This leads to laxity of ligament, joint dislocation,bone and cartilage being damaged anddeformity of the foot

2, 12 # 15


18/23

Pathophysiology -Anatomical Classification

Images: Johnsen, 2007

2, 12 # 15


19/23

Charcots Foot

2, 12 # 15


20/23

Resulting deformities

Pes planus with rear foot being valgusor varus

External rotation

Valgus forefootThick calluses with underlying ulcers

2, 12 # 15


21/23

Charcots Foot

2, 12 # 15


22/23

Objectives

Accommodate existing deformity

Prevent further progression ofdeformity

Reduce bending stressesUnload foot as needed

2, 12 # 15


23/23

Treatment

Total Contact Cast or

non-weight bearingAssisted weight-bearing

Accommodativefootwear and insole

the insensate foot

Documents