Injury before 1 month No pain What should do in this pt?

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55 yrs man with uncontrolled diabetes has asymptomatic , h/o rat bite of left great toe 6 yrs back, peripheral neuritis, tingling numbness+. dx

A 65 years old lady presented with a case of non healing ulcer over right fore foot 2nd toe plantar aspect since 2 years and left foot for foot over since 3 years associated with history of foul smelling pis discharge and cellulitis and fever since 15days for this they came. BP 160/90 Lab routine TC 16000 DC (N) 84% HB 13 gm RBS 317mg/dl ABI bilateral 0.9 TBI bilateral 0.8 Provisional diagnosis Grade2 B Neurotrophic ulcer bilateral A/ w cellulitis and osteomyelitis ? Over 2nd phalanx right foot Type 2 Diabetes MELLITUS Hypertension Diabetic peripheral Neuropathy Discussion open my dear colleagues and respected seniors

This 45yrs old woman having ulcer on her Lt foot plantar surface which you can see . She gives h/o about 6-8 months she is suffering !!!! One of my Pt related to her brought to my clinic on Monday 13-6-16.During this 6-8 months period many GP and one consultant surgeon has seen her Blood reports were carried out she is not at all Diabetic.Drs were giving her antibiotics and regular dressing was carried out according to her !!!!Antibiotics of up to ZIFI-TURBO 1bd for 10days given.when she does not get result she goes on changing Drs

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.