A 45 year old female presented with this non healing wound due to toe-ring over second toe anterior aspect of left foot for past 10days. She has been getting injection cefotaxim twice daily from another practitioner. She is a known case of T2DM. Weight - 55 kg Height - 165cm BMI - 20.22 Her present RBS is 260mg/DL I have asked her to get HBA1C, FBS AND PPBS, which I will update soon. Meanwhile sir what antibiotics, OHA and topical application would be best suitable for such patient. @Sepuri Krishna Mohan Sir, I need your valuable advise too.

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A diabetic foot ulcer is a frequent complication of diabetes mellitus. 25% of diabetic patients will develop a DFU during their lifetime.(1) The risk of developing a diabetic foot ulcer increases with the time. Unfortunately, the majority of foot and lower leg amputations are performed on patients with diabetes mellitus. The top priority in treating the diabetic foot syndrome is to avoid a major amputation. It is well known that 85% of amputations can be avoided with a holistic care plan.(4) Diabetic patients are at risk from foot ulcerations due to both peripheral and autonomic neuropathy as well as macro- and microangiopathy. Peripheral neuropathy (sensory and motor) is the most frequent cause of foot ulceration. As many patients with sensory neuropathy suffer from altered or complete loss of sensation in the foot and leg, any cuts or trauma to the foot can go completely unnoticed for days or weeks. Motor neuropathy may prompt muscle weakness (muscle atrophy), causing foot deformities which subsequently can lead to an inappropriate weight redistribution. Tissue ischemia and necrosis may occur, causing ulcerations. Additionally, autonomic neuropathy can lead to decreased sweating due to denervation of dermal structures. This induces dry skin, causing fissures, which increase the risk of infection. Diabetic angiopathy is another risk factor for developing diabetic foot ulcers and infections, as larger arteries calcification (macroangiopathy) and small arteries capillary basement membranes thicken (microangiopathy) this can lead to impaired microcirculation. Holistic approach Successful diagnosis and treatment of patients with DFUs involves a holistic approach that includes: Optimal diabetes control Effective local wound care Infection control Pressure relieving strategies Restoring pulsatile blood flow Adv:- Augmentin-625 Metrogyl400 Chymoral forte Severty of pain Controll Diabetes level. Mupirocin oint.

Tnx "Dr.Pushkar Bhomia Sir"
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Uncontrolled diabetic pt Sustained injury to toe and developed a nonhealing ulcer Needs to control the sugar by insulin Regular insulin sc as well as infiltration of few drop on wound I will irrigate with NS and dress with placentrax gel Oral antibiotics like amoxyclav625mg 1bd and tab lenazolinid 600mg 1bd This wound would heal in due course of time

Thanx dr A Dutta
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First of All strictly Controlled Sugar, Clean wound , Send Pus for Culture, ?Diabetic Foot Ulcer ? Soft tissue Necrotizing Infection Suggestive Necrotizing Fasciitis

* CLEANING DEBRIDEMENT AND DRESSING WITH ANTISEPTIC ANTIBIOTICS MUPIROCIN.. * STRICT GLYCEMIC CONTROL WITH ANTIDIABETIC MANAGEMENT WITH EXPERTS OPINION.. * ANTIBIOTICS WITH NSAIDS AS PER REQUIREMENT..TO CONTROL INFECTION & INFLAMMATION.. * PUS C AND S EXAMINATION.. * SURGEONS OPINION FOR WOUND MANAGEMENT..

Tnx Dr Shivraj Agarwal sir
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1st of all, any sort of DFUs should be preferably maintained optimal blood sugar control. If we opt for strict blood sugar control, then due to impaired vascularity the patient may develop gangrene & lodge on amputation. In this case she should be given basal-bolus regimen of insulin. Thoroughly debride the wound, daily dressing with superoxide solution (Oxum) & Mupirocin Oint. Maintain personal hygiene, foot care & no tight dressing. Antibiotics along with Antifungal treatment will help as it was caused by toe-ring & other web spaces look like fungal infections. Silver nano socks will be helpful.

@Dr. Jagadish Behera @Dr. A.k. Baliarsinha @Shrikant Bhoyar @Sepuri Krishna Mohan your valuable opinions please.
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Diabetic foot Tab Ceftum c v 1000 mg b d T Bact oint locally Nsaid orally Strict control of diabetes with Basal insulin & metformine

Right control of DM with preferably with insulin. Rest , Fucidin oint dressings, oral amoxyclav+ metronidazole, a short course of Fluconazole, Proper footwear, since she has diabetes induced claw toes .

Thank you, Doctor
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Diabetic foot with non healing infected ulcer Inj insulline with glycogen gp3 Tab istamet bd Tab PIOZ 30 od Venous Doppler to rull our venous stasis Antibiotics Antiinflsatory Fucibact onitment

Diabetic foot ulceration

Diabetic foot start Basal insulin and Metformin Antibiotic and NASID

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