PC Diabetic Foot Care & Wound Management 1 — Questions and Answers
Question 1: Which classification system is most widely used to grade diabetic foot ulcers in clinical podiatric practice?
- Wagner Classification System (Correct answer)
- Meggitt-Durham Scale
- Gustilo-Anderson Classification
- Salter-Harris Classification
Correct answer: Wagner Classification System
The Wagner Classification System (grades 0–5) is the most widely adopted grading tool for diabetic foot ulcers, assessing depth and presence of infection or gangrene.
Question 2: A patient with diabetes presents with a painless plantar ulcer and absent Achilles reflex. Which underlying condition is most likely contributing to the ulcer formation?
- Peripheral arterial disease
- Diabetic peripheral neuropathy (Correct answer)
- Osteomyelitis
- Charcot neuroarthropathy
Correct answer: Diabetic peripheral neuropathy
Absent deep tendon reflexes combined with a painless ulcer are hallmark signs of diabetic peripheral neuropathy, which impairs protective sensation and leads to pressure-related ulceration.
Question 3: When performing the monofilament test (Semmes-Weinstein) for diabetic neuropathy screening, which filament size indicates loss of protective sensation?
- 1 g (5.07 monofilament)
- 4 g (5.46 monofilament)
- 10 g (5.07 monofilament) (Correct answer)
- 10 g (6.10 monofilament)
Correct answer: 10 g (5.07 monofilament)
Inability to perceive the 10-gram (5.07 Semmes-Weinstein) monofilament at any plantar site indicates loss of protective sensation in diabetic patients.
Question 4: In managing a Grade 2 Wagner diabetic foot ulcer with suspected deep-tissue infection, which imaging modality is most sensitive for detecting osteomyelitis?
- Plain radiograph (X-ray)
- CT scan
- MRI (Correct answer)
- Bone scan (technetium-99m)
Correct answer: MRI
MRI is the most sensitive and specific imaging modality for detecting osteomyelitis in the diabetic foot, allowing visualization of bone marrow edema and soft tissue involvement.
Question 5: Which ankle-brachial index (ABI) value range is considered indicative of severe peripheral arterial disease requiring vascular surgery referral?
- 0.9–1.3
- 0.7–0.89
- 0.4–0.69
- Below 0.4 (Correct answer)
Correct answer: Below 0.4
An ABI below 0.4 indicates critical limb ischemia and severe peripheral arterial disease, warranting urgent vascular surgery consultation to preserve limb viability.
Question 6: Which offloading device is considered the gold standard for treating plantar diabetic foot ulcers?
- Removable cast walker
- Total contact cast (TCC) (Correct answer)
- Therapeutic footwear with custom insole
- Felted foam padding
Correct answer: Total contact cast (TCC)
The total contact cast (TCC) is the gold standard for offloading plantar diabetic foot ulcers because it cannot be removed by the patient, ensuring consistent pressure relief.
Question 7: A diabetic patient presents with a warm, swollen, erythematous foot with marked temperature asymmetry but no open wound. X-ray reveals joint fragmentation. What is the most likely diagnosis?
- Acute gout flare
- Cellulitis with abscess
- Charcot neuroarthropathy (acute phase) (Correct answer)
- Deep vein thrombosis
Correct answer: Charcot neuroarthropathy (acute phase)
Acute Charcot neuroarthropathy presents with warmth, swelling, and erythema in a neuropathic diabetic foot, often mimicking infection; joint fragmentation on X-ray confirms the diagnosis.
PC Diabetic Foot Care & Wound Management 1
Which classification system is most widely used to grade diabetic foot ulcers in clinical podiatric practice?