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Lower Extremity and Foot Assessment and Risk Determination

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Presentation on theme: "Lower Extremity and Foot Assessment and Risk Determination"— Presentation transcript:

1 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

2 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

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

4 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

5 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

6 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

7 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

8 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

9 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

10 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

11 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

12 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

13 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

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

15 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

16 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

17 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

18 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

19 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

20 **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

21 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

22 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

23 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

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

25 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

26 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

27 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

28 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

29 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

30 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

31 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

32 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

33 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

34 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

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