20.1: Orthopaedic Implications for Patients With Diabetes

State of Ohio Approval #: 10S268, Hours granted: 30, Effective dates: 1/1/10-1/1/11; PA State Board of PT Approval #: PTCE001061, Date of course: 12/24/10-12/31/10, Number of credits: 30 (30 gen, 0 DA); NV Board of PT Examiners Approved for 1.5 CE Units, Unit type: Clinical, Approval through: 7/31/11; State of CA approval: (CPTA #10-140), 3.0 CEUs, dates: 2/1/10-2/1/2011; State of TX granted for: 3 continuing education unit (CEUs), Valid: 01/01/2010 - 12/31/2010, Approval #: 47145A; OK Board of Medical Licensure and Supervision Approved for: 30, Category: B Hours for the 10-11 reporting period.

Course Description

Coverage of orthopaedic issues and implications related to physical therapy for the patient with diabetes. Specific topics include the effects of diabetes on youth and also foot pathology and foot care recommendations. Details on evaluative procedures and treatment planning and exercise considerations using an evidence-based approach are emphasized throughout.

Upon completion of this course the participant will be able to do the following:

1. Discuss the spectrum of etiologies and symptoms that lead to classification of diabetes diagnoses.
2. Identify the inflammatory molecules released by adipose tissue and describe their interaction with the insulin receptor in skeletal muscle.
3. Relate risk factors from obesity to diabetic pathology.
4. Understand the factors that affect bone structure and development in the diabetic child.
5. Describe macrovascular and microvascular complications in youth including neuropathy and limited joint mobility.
6. Discuss general guidelines for exercise in youth with diabetes.
7. Describe the etiology of type 1 and type 2 diabetes and identify the risk factors for both types of diabetes and their effects on treatment planning.
8. Describe how diabetes adversely affects skeletal muscle and how this could contribute to exercise dysfunction.
9. Describe how diabetes adversely affects fat metabolism and how this could contribute to exercise dysfunction in those with diabetes.
10. Identify the treatment implications for exercise prescription of a diabetic patient taking insulin sensitizing medications and/or insulin.
11. Describe the cardiovascular implications of diabetes and how exercise training may modify the increased cardiovascular risk associated with the disease.
12. Identify the role that physical therapists may play in the prevention and treatment of type 2 diabetes.
13. Describe the role of the skin, its layers, and contents in the process of wound healing.
14. Identify wound types and classifications and describe the phases of normal wound healing.
15. Describe the interventions, physical agents, and topicals and dressings used for wound care.
16. Describe the causal pathway to diabetic amputation and the role diabetes plays in the pathway.
17. Recognize co-morbidities in the physical examination which require further workup examination.
18. Interpret basic radiographic images and their implication in management of the diabetic patient.
19. Discuss the complicated nature of managing diabetic patients' foot and ankle deformities.
20. Describe how a patient with diabetes would present if they were at risk for Charcot neuropathy.
21. Identify the risk factors associated with diabetic foot dysfunction.
22. Describe common foot pathologies associated with diabetes mellitus.
23. Explain the components of a comprehensive foot assessment for the patient with diabetes mellitus.
24. Integrate the results of the physical therapy examination and evaluation to develop a comprehensive physical therapy intervention plan.
25. Describe the features and prescription of protective footwear for patients with diabetes mellitus.

• The Role of Obesity in Diabetes- Lisa Stehno-Bittel, BSPT, PhD
• Diabetes in Youth: Impact of Diabetes on Growth, Development, and Maturation- Mary Wills Jesse, PT, DHS, OCS
• Metabolic and Cardiovascular Effects of Exercise in the Adult With Diabetes-W. Todd Cade, PT, PhD
• Wound Management and Diabetes-Cordell Atkins, PT, DPT, CWS, CDE, CPed
• Orthopaedic Management of the Diabetic Foot-Dane K. Wukich, MD; Ryan L. McMillen, DPM; and Nicholas J. Lowery, DPM
• Complications and Interventions for Pathology of the Diabetic Foot- Nancy K. Shipe, PT, DPT, OCS

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