Non healing diabetic foot ulcer.

80 year old male with history of DM, PVD, related to non healing diabetic foot ulcer. Now has this area on top of left foot. Has had this scab since earlier this year. Has not grown in size. No odor, no drainage, no pain. Reports no fevers. Has mild neuropathy to LLE. Suggestions on any further treatment options/tests? Worried about what may be presenting underneath the scabbed area with his Hx of PVD/DM.

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Old man 80yrs of age having DM and PVD also has peripheral diabetic neuropathy Nonhealing ulcer foot with gangrenous scab And diffuse subcutaneous oedema and cellulitis Now neuropathic ulcers are painless hence pt cannot appreciate the severity of complications He also has PVD that is headache to understand the blood supply of area affected So strict control of diabetes on insulin Colour doppler to study the blood supply Take the case for debridement Explore maximum necrosed tissue and remove in one stage H2O2 and NS irrigation Dressings with silverex neo Broadspectrum antibiotics like Lenazolinid 600mg 1bd Tab amoxyclav625mg 1bd Keep leg at rest and raised In this case i suspect you may have to face a situation of Amputation

Thanx dr Vipin Bihari Jain
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Diabetic foot /Diabetic occlusive vascular disease. Strict diet control by medicine,diet , change of life. Need x-ray foot and doppler test to conclude. Debridement and dressing with betadine lotion covered with sofra tullu gauge under LA. Inj ceftam 1gm iv bd slowly. Atovastin Ecosprin Multivitamin and antioxidant orally. Keep the area clean and raised. If obstruction than surgical intervention.

Thanks Dr Pushkar Bhomia
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K/C/O T2DM with PVD and non healing diabetic foot ulcer.... P/w wound with Blackish discoloration looks like a ulcer... In view of history, rule out Venous insufficiency and do a USG Doppler... Strict diabetes control cant be overlooked Surgical opinion for better control of wound...

Diabetic neuropathy Strict control of diabetes The wound should be opened & necrotic tissue should be removed Antibiotics orally Antibiotics locally dressings See for vascular defeciency Nerve conduction velocity

DM..of which level ?. Duration of diabetes..~ Very common to havediabetic neuropsthy to devrlop gangerious non heaing woumd.. Get 3D doppler to access cellulitis or vasculitis ?

Diabetic ulcer with scab formation Adv Strict control of diabetes Medication to improve vascularity Atorvastatin Ecosprin Cilostazole Antibiotics Limb elevation Doppler to look for stenosis of blood vessels and if required Angiography with Angioplasty

I agree with Dr Jayesh.. continue same
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Dry superficial gangrene ,diabetic foot, diabetic occlusive vascular disease Suggest Tight control DM Xray foot to rule out OM Biopsy from edge of ulcer Arterial color doppler to check for vascularity. Stenting if there is obstruction. Antibiotics, excision o the gangrene and dressings/ skin grafting .

Strictly controlled Diabetes use Insulin
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Diabetic Occlusive Vascular disease Diabetic Neuropathy with tropic ulcer

Diabetic neuropathy Cellulitis Adv : HBA1C , pus c/s CBC Cret T/t antibiotics Chymoral forte Fucibact application Limb elevation

xrays to exclude osteomyelitis or bony changs underneath , give augmentin and foot elevation with magsulf compression , optimise the blood sugar level and base line blood investigations if there is any high cell count. review after 3 days

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