Concluded Case

Diabetic , neuropathic ,infectious gangrenous,hemiplegia all in left.

She is 60 plus ,Diabetic for the last 10 years ,on irregular treatment ailing from the rural ,poor background of agricultural labour.Foot is anaesthetic ,due to DIabetic neuropathy .Thorn prick at the base of the ball of left great toe.Painless ,swelling with abscess sole with pus pouring and taking local treatment from quack.One month she was on daily dressing. A week before that is 204.2120/patient developed hemiplegia on left side,that is left abscess sole side ,was affected, upper limb,flaccid paralysis and lower limb ,tone is maintained ,not placid and move the knee for painful stimulus at the sole. Discuss the pros and cones on the management of the case in a rural set up ,in COVID19 pandemic situation,where the transport is absent. I am in a small taluk town .Patient is from small hamlet. On day one ,when she was brought to me by her relatives ,her blood sugar was more than 600 mg in the glucometer ,CBG value.Tongue was dehydrated. Semiconscious. .Intravenous normal saline ,plain insulin low dose on hourly use by Glucose monitoring ,she recovered.. Now her GC good,Diabetes well managed. Discuss the case. Necrotic ,soft tissues gangrenous ,debris are removed.Great toe ,first phalanx was exposed ,skin and connective tissue covering were dead and slough ,all were removed. Ball of the great toe skin fairly covered with skin but cold and clammy. plantar abscess opened at multiple points to drian the pus,because it is not well localized.

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Concluded answer
She is known diabetic.Diabetic foot ulcer was un cared due to anaesthetic feet, for months together.Meanwhile patient developed stroke to the right internal capsule and patient reported to me for the stroke and affecting placid paralysis left upper limb and paresis for the left lower limb.Face is spared not affected by facial weakness . CT scan shows infarct . Foot examination revealed gangrenous great toe left ,and plantar abscess. Toe was ampited.Abscess drained at multiple points . Due to hemiplegia ,patient is not able to use the sole to carry her load on static and kinetic purpose ,made the diabetics ulcer foot to heal faster. I will.post the photo . So gangrenous foot in a hemiplegic sole is added advantage to treat the ulcer fast.
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Diabetec Gangrene. Peripheral Neuropathy involved. Very poor diabstic controll. Gangrene usually affects diabetics with high and uncontrolled blood sugar. It is found that high blood sugar damages the nerves of the foot causing peripheral neuropathy and also hardens the walls of the arteries leading to narrowing and obstructed blood supply. Gangrene typically affects the toes, fingers, and limbs. It can also affect your muscles or organs, but this isn’t as common. This condition is generally characterized by discolored skin, feelings of numbness, and unusual formation of discharge or pus. If patient develops a wound infection in one of his/her feet as a result of peripheral neuropathy, there's a risk this could lead to gangrene (death of part of the skin or underlying tissues). ... In severe cases patient's toe or foot may need to be amputated
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She is known diabetic.Diabetic foot ulcer was un cared due to anaesthetic feet, for months together.Meanwhile patient developed stroke to the right internal capsule and patient reported to me for the stroke and affecting placid paralysis left upper limb and paresis for the left lower limb.Face is spared not affected by facial weakness . CT scan shows infarct . Foot examination revealed gangrenous great toe left ,and plantar abscess. Toe was ampited.Abscess drained at multiple points . Due to hemiplegia ,patient is not able to use the sole to carry her load on static and kinetic purpose ,made the diabetics ulcer foot to heal faster. I will.post the photo . So gangrenous foot in a hemiplegic sole is added advantage to treat the ulcer fast.
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