Concluded Case

Charcot's of MTP Joints.,due to DM with DFU.

Mrs X is brought to me for the non healing diabetic foot ulcer .This DFU is present for more than a year. Her 4 the toe was amputated two year before for the gangrene . The diabetic foot ulcer was 5 inches ×5 inches in size ,circular on metatarsal region of load bearing areas. There is abscess ,located posterior to the DFU. It is drained,and it is connected with ulcer. X ray foot shows Charcot joints of 2 and 3 metatarsophalagial joints. Due to previous amputation of 4th toe ,free metatarsal end is visible. Patient is put on Bed rest ,DFU is managed well and ulcer is well healed. Fresh x ray foot revealed the same pathology of MTP joints destruction and disarticulation of the same. If patient is about to walk.The bone and joint disease of MTP will further damage the sole . How to help the patient . Anaesthetic foot due to sensory nueropathy , Diabetic Charcot's joints ,may prone for further injuries to the sole. How help. Orthopedics opinions are needed.

(Edited)

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Concluded answer

This patient has undergone toe amputation .Same foot have developed the pressure ulcer was extending ,and occupying whole of Forefoot ,at the MT Regions of sole. With this wide ulcer ,she was carrying out her daily routines ,using the sole on the same ulcer bed,hence it was non healing as well as poorly controlled sugar augments sole pathology of ,sensory loss loss of soft tissues , and,loss of proprioceptive sensory lose of bony joints of Metatarsal and phalanx result in Charcot joints and dislocation of MTP joints,which is evident in the Xray .This Charcot joints are under the ulcer floor base further damaged the joints and its destruction, is seen there. DFU ,gave to infection which formed the abscess. It was drained ,complete bed rest ,and callus around the DFU was removed ,well managed the DM with multiple insulin doses and antibiotics, with supportive dressing healed the ulcer ,it was saucer shaped ,well healed . The DFU was 10cm@×10cm size well responded to the bed rest .

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Diabetic foot is well healed Now to prevent recurrent ulcer formation Following steps can be taken 1 - strict control of blood sugar with insulin 2 - The ulcer is on forefoot and Charcot foot involves forefoot Therefore offloading of forefoot with special footwear such as front orthowedge footwear may help prevent recurrent ulcer The

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We have managed cases like this with neuropathic foot and ulceration in diabetics and leprosy with walking casts. It redistribute pressure and help in healing. After that foot wear modification. Inhouse orthopaedic surgeon can decide.

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Trophic ulcer or Diabetic foot ulcer. Rx-1-strict and optimum control of diabetes.by inj mixtard. 2-proper debridement and cleaning of wound with saline.and dress with povidone+ornidazole ointment locally. 3-if osteomylitis of MTP joint then debridement of MTP joint.l 4-bed rest and minimum movement of foot. 5-antibiotics and analgesic andantiinflamatory drugs. 6-cap vitaminc 1o

This patient has undergone toe amputation .Same foot have developed the pressure ulcer was extending ,and occupying whole of Forefoot ,at the MT Regions of sole. With this wide ulcer ,she was carrying out her daily routines ,using the sole on the same ulcer bed,hence it was non healing as well as poorly controlled sugar augments sole pathology of ,sensory loss loss of soft tissues , and,loss of proprioceptive sensory lose of bony joints of Metatarsal and phalanx result in Charcot joints and dislocation of MTP joints,which is evident in the Xray .This Charcot joints are under the ulcer floor base further damaged the joints and its destruction, is seen there. DFU ,gave to infection which formed the abscess. It was drained ,complete bed rest ,and callus around the DFU was removed ,well managed the DM with multiple insulin doses and antibiotics, with supportive dressing healed the ulcer ,it was saucer shaped ,well healed . The DFU was 10cm@×10cm size well responded to the bed rest .

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1

Main aim is to reduce pressure on the joint, no weight bearing **Walker should be used **First target is to heal the diabetic foot ulcer completely Risk of fracture should be avoided *Orthopedic opinion needed

Use insulin dressing Soak every morning foot in a betadine and ns with h2o2 solution Use Placentris with vancomicin powder paste application over the wound Start all multivitamins and antioxidants See for cbc hb levels if low transfuse whole blood Put vit c every day and vit d weekly Might heale by gods grace if u follow above thinks Forget about chariots joint

This foot ulcer is well healed .
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Diabetic foot ..healing?

Sir, Make sure his Glycemic levels under control ,. Get a Doppler of effected limb both arterial and venous , EUSOL bath of effected foot , And Sent pus for C& S , then decide Antibiotics, Daily local debridement during Regular dressing , we Can proceed with fore foot amputation.

This is well healed DFU.
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