APMLE Part II key terms

Progressive destruction of weight-bearing foot and ankle joints in patients with sensory neuropathy, producing warmth, swelling, and deformity without proportionate pain; often misdiagnosed as infection or gout early in its course.

Screening tool using a calibrated nylon filament pressed against designated plantar sites to detect loss of protective sensation; inability to feel the 10-gram filament signals high ulceration risk.

Ratio of systolic pressure in the ankle to that in the arm, measured with Doppler; values below 0.90 suggest peripheral arterial disease, while values above 1.30 suggest noncompressible calcified vessels.

Noninvasive measurement of oxygen diffusion through skin via heated electrode, used to estimate local perfusion and predict whether a wound or amputation site will heal.

Breakdown of plantar skin and underlying tissue in a person with diabetes, typically at pressure points, driven by neuropathy, ischemia, and repetitive mechanical load.

Redistribution of mechanical stress away from a wound using casts, boots, or orthoses so tissue can repair; total contact casting is the standard for neuropathic plantar ulcers.

Well-molded plaster or fiberglass cast that conforms to the entire foot and lower leg, distributing load and limiting ambulation to promote healing of plantar neuropathic ulcers.

Six-grade scale describing diabetic foot wounds from intact skin (grade 0) through superficial ulcer, deep ulcer, abscess or osteomyelitis, localized gangrene, and extensive gangrene.

Bone infection, often from contiguous spread in diabetic foot wounds; diagnosis rests on probing to bone, imaging, inflammatory markers, and bone culture rather than surface swab alone.

Bedside maneuver in which a sterile blunt probe touches bone through an ulcer; a positive result raises the likelihood of underlying osteomyelitis substantially.

Lateral deviation of the great toe at the first metatarsophalangeal joint with medial prominence of the first metatarsal head; severity is described by intermetatarsal and hallux valgus angles.

Painful bony and soft-tissue prominence over the medial first metatarsal head, commonly accompanying hallux valgus and aggravated by narrow toe box footwear.

Surgical fusion of the first metatarsophalangeal joint used for advanced hallux valgus, hallux rigidus, or salvage; it reliably relieves pain at the cost of lost joint motion.

Degenerative arthritis of the first metatarsophalangeal joint causing pain and restricted dorsiflexion, with a dorsal osteophyte that impinges during push-off.

Degenerative irritation of the plantar fascia origin at the medial calcaneal tuberosity, producing first-step heel pain that lessens with activity and worsens again after rest.

Tightening of the plantar fascia during great toe dorsiflexion that elevates the medial longitudinal arch and stabilizes the midfoot through late stance.

Bony outgrowth at the plantar or posterior calcaneus seen on lateral radiographs; frequently incidental and not by itself proof of the pain's source.

Painful degenerative change in the Achilles tendon from repetitive loading, causing morning stiffness, thickening, and nodularity; managed initially with eccentric loading exercise.

Calf squeeze maneuver; absence of plantarflexion when the gastrocnemius is compressed indicates a ruptured Achilles tendon.

Elevated pressure within a closed fascial space that compromises perfusion; presents with pain out of proportion, tense swelling, and pain on passive stretch, and requires urgent fasciotomy.

Palpation of dorsalis pedis and posterior tibial arteries to assess distal perfusion; palpable pulses do not exclude significant arterial disease in calcified diabetic vessels.

Plain films obtained to detect bone destruction, periosteal reaction, gas, or foreign bodies; findings may lag weeks behind infection and normal films do not rule out osteomyelitis.

Cross-sectional imaging with high soft-tissue and marrow contrast, useful for delineating abscess, sinus tracts, and bone infection; marrow edema can mimic infection after surgery.

Practice of selecting the narrowest effective agent, dose, and duration guided by culture and clinical response, avoiding unnecessary broad-spectrum therapy that promotes resistance.

Collection of specimens after sharp debridement and cleansing, ideally by tissue biopsy or curettage rather than superficial swab, to avoid misleading colonizing organisms.

Documented discussion of diagnosis, proposed procedure, material risks, alternatives, and consequences of declining, obtained from a patient with decision-making capacity before treatment.

Clinical judgment that a patient can understand relevant information, appreciate consequences, reason about options, and communicate a consistent choice; distinct from legal competence.

United States law governing privacy and security of protected health information, limiting disclosure without authorization and setting rules for minimum necessary use.

Symmetrical, length-dependent nerve damage from chronic hyperglycemia causing stocking-distribution sensory loss, burning pain, and increased fall and ulcer risk.

Atherosclerotic narrowing of lower extremity arteries producing claudication, rest pain, or nonhealing wounds; confirmed with ankle-brachial index and vascular imaging.

Crystal arthropathy from monosodium urate deposition causing acute monoarthritis, classically of the first metatarsophalangeal joint, with erythema, swelling, and extreme tenderness.

Joint infection requiring urgent aspiration and intravenous antibiotics; it mimics gout but is distinguished by synovial fluid analysis with elevated white count and positive Gram stain or culture.

Reduced bone mass and microarchitectural deterioration that raises fracture risk; relevant to stress fracture evaluation and to medication effects such as glucocorticoid-induced bone loss.

Bone failure from repetitive submaximal loading, presenting as focal activity-related pain with tenderness; early radiographs are often normal, and MRI or bone scan confirms it.

Collaborative conversation style that elicits a patient's own reasons for change through open questions, reflective listening, and affirmation, often used for adherence and smoking cessation.

Process in which clinician and patient exchange evidence and patient values to choose a treatment together, supporting autonomy and realistic expectations for surgical or conservative care.

Analgesic and anti-inflammatory agents that inhibit cyclooxygenase; useful for musculoskeletal pain but carry gastrointestinal, renal, and cardiovascular risk, especially in older or diabetic patients.

Local delivery of glucocorticoid into a joint or soft-tissue space to reduce inflammation; requires aseptic technique and caution in infection, coagulopathy, or poorly controlled diabetes.

Removal of devitalized tissue, callus, and debris with a sterile instrument to expose healthy tissue, reduce bacterial burden, and permit accurate wound assessment.