45yrs diabetic male.. with this tropic ulcer since 1 yrs.. Treated by various doctors .. The ulcer area heals and recurs again at the same spot.. Too much keratinization seen surrounding it .. No sensation of pain felt.. Debridement and dressing done (with megaheal) by me along with antibiotics (augmentin).. Tough diabetes is controlled and brought below 180 post lunch.. No other comorbidities present.. Kindly guide me with the management and m also worrisome regarding it reoccurring... Thank you...

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Diabetic foot. It is is any pathology that results directly from peripheral arterial disease (PAD) and/or sensory neuropathy affecting the feet in diabetes mellitus; it is a long-term (or "chronic") complication of diabetes mellitus. Strictly controle of Diabetes ** Keeping wounds clean and dressed ** Wearing immobilization devices, such as a cast boot or total contact cast.. **Closely observing any gangrene on the toes until self-amputation occurs, which is when the toes fall off due to lack of blood flow. ** Surgical intervention.

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Diabetic foot Yes trophic ulcer needs debridement Base of ulcer appears healthy Dress after irrigation with h2o2 and NS Let granulation to take place do normal saline sterlised dressings Offloading of wt Complete rest to foot Oral antibiotics tab lenazolinid 600mg 1bd if needed

Thanx dr Mandakini Naikwade
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? DIABETIC ULCER FOOT.. NEED'S.. STRICT GLYCEMIC CONTROL WITH ANTIDIABETIC MANAGEMENT WITH EXPERTS OPINION.. WOUND MANAGEMENT WITH SURGEON'S OPINION.. CLEANING.. DEBRIDEMENT AND DRESSING WITH MUPIROCIN.. X-RAY STUDY.. COLOUR DOPLAR STUDY.. SWAB C AND S EXAMINATION.. HBA1C.. BS..ANTIBIOTICS WITH..NSAIDS AS PER REQUIREMENT

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I will share my interaction few years back with very senior and respected diabetic foot surgeon who has managed thousands of cases.  It was my good fortune that he was kind to read my book MONOGRAPH ON LEPROSY.  He also recommended my book. After reading the book he commented that now he knew why few of his patients did not improve in spite of all possible therapeutic measurements. The associated leprosy were missed even by dermatologists in such cases. The purpose of my answer is make to aware to  diagnose and treat associated leprosy in such cases. Thank you for reading my answer.

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It is a case of unhealthy trophic ulcer due to diabetic neuropathy due to loss of sensationband usually happens on the pressure point like metatarsophalangeal joint. Due to loss of sensation pt goes on walking and causes repeated friction with keratisation ultimately sets infection . Strict diabetic control Debribement of the dead tissue till there is normal bleeding . The regular deressing with debribement till the wound is healthy with healthy granulation tissue formed.the to consider for covering the wound with flap or rotation graft.

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Thanks to Dr Faizan Khan for his request to answer regarding this case of Trophic Ulcer in DM. Why do few patients like this case of Trophic Ulcer due to DM  not improve in spite of all possible measures? My answer is as follows. Unsuspected, not diagnosed and not treated associated leprosy in such cases. Peripheral Neuropathy due to associated leprosy progress to cause more and more nerve damage unless diagnosed and treated early.

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Diabetic foot. Cleaning, debridgement and dressing with mupirosin. Antidiabetic management to achieve good glycemic control. Antibiotics , nsaid. Investigations. Xray study. Bsr Hba1c. Pus c&s examination.

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Neuropathic ulcer Only way to heal it is by offloading it Front Ortho wedge foot wear, bed rest may help

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Diabetic trophic non healing ulcer Granulation ok Xray CT angiogram Opinion of vascular surgeon Diabetic diet strict diabetes control

Or opinion of podiotrist
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Diabetic foot Strict control of diabetes Antibiotics orally antibiotics locally Nsaid orally

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