APMLE Part III key terms

Progressive destruction and deformity of weight-bearing joints in a person with peripheral neuropathy, often triggered by minor trauma. The foot becomes warm, red, and swollen, and collapse can lead to rocker-bottom deformity and ulceration.

Loss of the medial longitudinal arch with plantar convexity of the midfoot, usually from collapse of the tarsometatarsal and midtarsal joints. The prominent plantar bony surface predisposes to pressure ulceration.

A calibrated nylon filament used to screen for loss of protective sensation. Inability to feel the 10-gram filament at designated plantar sites identifies patients at high risk for diabetic foot ulceration.

Reduced plantar sensation severe enough that the foot cannot reliably detect injurious pressure or trauma. It is a major independent risk factor for ulcer formation and is assessed by monofilament or vibration testing.

A full-thickness break in the skin of the foot in a person with diabetes, typically at sites of repetitive pressure in the setting of neuropathy or ischemia. It is classified by depth, infection, and perfusion to guide treatment.

A grading system for diabetic foot wounds ranging from grade 0 (intact skin with deformity) through grade 5 (whole-foot gangrene). Higher grades indicate deeper tissue loss and greater amputation risk.

Reducing mechanical pressure on a wound or at-risk area using devices such as total contact casts, removable walkers, or felt padding. Adequate offloading is essential for healing plantar neuropathic ulcers.

A well-molded plaster or fiberglass cast that conforms to the entire foot and lower leg to redistribute pressure. It is a standard treatment for plantar neuropathic ulcers and acute Charcot deformity.

Infection of bone, often from contiguous spread of an infected foot ulcer. Diagnosis uses probing to bone, imaging, and bone culture; treatment typically requires prolonged antibiotics and sometimes surgical resection.

A bedside maneuver in which a sterile probe passed through an ulcer reaches hard bone. A positive result strongly suggests underlying osteomyelitis and warrants further imaging or biopsy.

Lateral deviation of the great toe at the first metatarsophalangeal joint with medial prominence of the first metatarsal head. It causes bunion pain, altered mechanics, and sometimes transfer metatarsalgia.

The painful medial bony prominence at the first metatarsal head, usually accompanying hallux valgus. Symptoms arise from shoe pressure, bursitis, and altered joint mechanics rather than the deformity alone.

Pain in the ball of the foot, usually under the lesser metatarsal heads, from overload, altered mechanics, or fat-pad atrophy. Treatment includes padding, footwear modification, and orthoses.

A painful thickening of the interdigital nerve, most often in the third web space, causing burning pain and numbness in the toes. It is worsened by narrow footwear and confirmed clinically or by imaging.

Degenerative irritation of the plantar fascia at its calcaneal origin, producing first-step heel pain. It is diagnosed clinically and managed with stretching, orthoses, and activity modification.

A bony projection on the plantar calcaneus visible on radiographs, often found incidentally in patients with plantar heel pain. It is not itself the usual source of symptoms.

Painful degeneration of the Achilles tendon from overuse, causing posterior heel pain and stiffness, especially after rest. Management includes eccentric loading exercise and load modification.

A complete tear of the Achilles tendon, often felt as a sudden pop with inability to push off or perform a single-leg heel raise. A positive Thompson test supports the diagnosis.

A bedside test for Achilles tendon rupture in which squeezing the calf fails to produce plantarflexion of the foot. Absence of movement suggests a complete tear.

The ratio of ankle systolic pressure to brachial systolic pressure, used to screen for peripheral arterial disease. Values at or below 0.90 suggest significant arterial narrowing.

Narrowing of limb arteries, usually by atherosclerosis, causing claudication, rest pain, or nonhealing wounds. Screening and risk-factor control reduce limb loss and cardiovascular events.

Severe limb hypoperfusion causing rest pain, nonhealing ulcers, or gangrene, often with ankle pressures markedly reduced. It threatens limb viability and requires urgent vascular evaluation.

Elevated pressure within a closed fascial compartment that impairs perfusion and can cause muscle and nerve death. It presents with pain out of proportion, and urgent fasciotomy may be required.

Absence or reduction of an expected arterial pulse on examination, such as the dorsalis pedis or posterior tibial pulse. It prompts further vascular assessment but does not alone confirm ischemia.

Formation of thrombus in a deep leg vein, causing unilateral swelling, pain, and risk of pulmonary embolism. Diagnosis relies on ultrasound, and treatment is anticoagulation.

Obstruction of pulmonary arteries by thrombus, usually from a leg vein, causing dyspnea, chest pain, and hypoxia. It is a life-threatening complication of deep vein thrombosis.

A clinical prediction rule that estimates pretest probability of deep vein thrombosis or pulmonary embolism. It guides whether to test with D-dimer or imaging.

A spreading bacterial infection of deep dermis and subcutaneous tissue causing warmth, erythema, and tenderness. It is usually treated with systemic antibiotics; abscess formation requires drainage.

A localized collection of pus within tissue, producing a fluctuant, tender mass. Treatment requires incision and drainage, with antibiotics as an adjunct.

A superficial bacterial skin infection with sharply demarcated, raised, erythematous borders, usually caused by streptococci. It is treated with antibiotics and distinguished from deeper cellulitis.

Reduced bone mass and microarchitectural deterioration that increase fracture risk. It is common in older adults and is managed with calcium, vitamin D, exercise, and pharmacologic therapy.

A fracture resulting from a fall from standing height or less, indicating weakened bone. It often signals underlying osteoporosis and warrants evaluation and treatment.

A group of metabolic disorders causing chronic hyperglycemia from insulin deficiency or resistance. Complications include neuropathy, peripheral arterial disease, nephropathy, and impaired wound healing.

A blood test reflecting average blood glucose over roughly the prior two to three months. It is used to diagnose and monitor diabetes and to gauge infection and healing risk.

The process of explaining a procedure's risks, benefits, and alternatives so a patient can voluntarily agree or decline. It requires decision-making capacity and documentation.

A patient's ability to understand relevant information and appreciate consequences well enough to make a specific decision. It is assessed clinically and is distinct from legal competence.