Concluded Case

chronic wound were present bilateral foot on the fore foot both side,in the 65 years aged women .The wound were there for more than two years. Left foot ulcer acutely exacerbates in to abscess sole with multiple sinuses X Ray left foot metatarsals were normal and phalanx in the all toes were missing due to chronic injury related infections and further healing was reported . Insensitive foot bilaterally present for all modalities of sensation . Discuss differential diagnosis and managements.

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This is old Leprosy MB case treated with multi drug regime of Dapsone ,RIF,Clofazamine under NLEP and released from treatment . Though treated for leprosy ,disease was cured but nerve complication of loss of sensation pushed her for anaesthetic feet .She is rural ,poor socioeconomic back ground ,daily life of mobility make her more prone for ulcer foot ,in the absence of sensation trauma produces ulcer. Due to disease ,loss of toes bilaterally the foot muscles inserting on the toes were lost.Therefore foot grip is lost in the bilateral feet. Hence static and kinetic force of the heel,mid stance,toe of phase on walking shits to the metatarsal heads of sole ,producing more stress and necrosis and ulcer feet in Hansen patient. Patient mean time developed Type 2/DM which trouble her in getting infection of old wound that produces the gangrene of sole ,and pus pointing out through sinuses. Sugar control, antibiotics,daily dressing will give good result.

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Trophic gangrenous ulcers foot b/l D/d 1 diabetic foot 2 leprosy 3 tubercular ulcers Sir proper debridement and drainage and dressings of ulcers with caring underlying cause may yield the results. Long duration not caring and working bare foot are aggravating factors.

Thanx dr Huzaifa Shafi
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IT'S A CASE OF.. D/D.. * DIABETIC FOOT/ DIABETIC ULCERS.. * LAPROSY..ULCERS.. * TUBERCULAR ULCERS.. * MALIGNANCY.. NEEDS CLINICOPATHOLOGICALLY EVALUATION.. HEMOGRAM.. URINE ROUTINE.. BSR..HBA1C.. SWAB C AND S EXAM.. TISSUE HISTOPATHOLOGICAL STUDY.. X-RAY STUDY ..

Tnx a lot Dr Jagjit singh
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Thank you curofy
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Leprosy Diabetic foot Tuberculous ulcer Needs thorough investigations

Thank you doctor
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This is the case of treated MB leprosy patient , treated with multi drug regime ,by NLEP. She was treated with ,Dapsone,Rifampicin , clofazimine for one year and released from the treatment some twenty years back. the disease was healed .But pain and temperature were lost .Motor fiber of foot intrinsic muscles were wasted and loss of toes result in flexor hallusis longus ,and digitorum longus and flexor hallusis longus gone for wasting due to toes loss .There fore foot grip over walking is lost and poor sensation is prone for injury and ulcer . Walking phase of toe off, is lost due to toes were lost. Hence tarsal bones of forefeet are loaded with more body weight and that static and kinetic force produces necrotic ulcers in both feet on fore feet. These bilateral foot ulcers were there for more than two years,with callous margins of ulcers It was not infective for the lost two years,but the wound got infected over the periods of last ten days. Patients was newly diagnosed type 2/DM. DM is highly prone for infection for pus forming organisms like staphylococcus, so left foot got infected luckily other sole is spared leaving Hanson disease ulcer without infection . This is Leprosy ,with. DM. Both the disease is notorious for foot pathology due to peripheral never damage. If leprosy patient is treated they have to be rehabilitated suitably to avoid tertiary complications. Here proper foot wear was advised such wound would have been avoided.

This is old Leprosy MB case treated with multi drug regime of Dapsone ,RIF,Clofazamine under NLEP and released from treatment . Though treated for leprosy ,disease was cured but nerve complication of loss of sensation pushed her for anaesthetic feet .She is rural ,poor socioeconomic back ground ,daily life of mobility make her more prone for ulcer foot ,in the absence of sensation trauma produces ulcer. Due to disease ,loss of toes bilaterally the foot muscles inserting on the toes were lost.Therefore foot grip is lost in the bilateral feet. Hence static and kinetic force of the heel,mid stance,toe of phase on walking shits to the metatarsal heads of sole ,producing more stress and necrosis and ulcer feet in Hansen patient. Patient mean time developed Type 2/DM which trouble her in getting infection of old wound that produces the gangrene of sole ,and pus pointing out through sinuses. Sugar control, antibiotics,daily dressing will give good result.

Trophic ulcer DD Leprosy Diabetic foot Tubercular ulcer Malignancy

Non sensory sole Repeated trauma Get biopsy Manage accordingly

Tab Depsone Tab clofazimine daily For 6-12 mths Or with Cap Rifampicin 600

Diabetic leg
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Check her diabetic status D/d Burger disease Daibetic leads Gangrene

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