Diabetic foot ulcer

proper clinical presentation of diabetic foot with photographic picture. each point analysed from surgical manual of Das.

1. CASE PRESENTATION RAMAGOPALAN S FINAL YEAR M.B.B.S. VELAMMAL MEDICAL COLLEGE

2. DEMOGRAPHIC DETAIIL: Name: Mr. Perumal samy Age/sex : 54 years, male Occupation: shop keeper Address: Madurai CHIEF COMPLAINT: Ulcer in the right foot for 2 months duration

3. Summery of history: A 54 years old Mr. Perumal samy presented with ulcer in the planter aspect of right foot for 2 months duration. It starts as small blister and rapidly turn into ulcer of present size. He was known diabetic for 14 years duration on regular medication and reformed alcoholic since 5 years, non smoker.

4. General examination: Patient was conscious, alert, afebrile and comfort at rest. No pallor, No icterus, No cyanosis, No clubbing, No lymphadenopathy, No pedal edema . Vitals: Pulse: 84 beats per minutes, regular rhythm, normal volume, no specific character. All peripheral pulses are felt Blood pressure: 134/82 mmHg in right upper arm in sitting posture Temperature: 98.2 degree F Respiratory rate: 14 breaths per minute. Height : 164 cm Weight: 88 kg BMI : 32.7 Systemic examination: normal

5. Local examination: of right foot Inspection: Site: planter surface of head of first metatarsal Number: single Size: 5*4 cm in size Shape: oval Edge : punched out Margin: well defined Floor: filled with slough and sero purulent discharge Discharge: sero purulent discharge Surrounding area: pale and inflamed Whole limb: Normal No similar feature in left lower limb

6. Local examination: of right foot Palpation: Tenderness: no tenderness on palpation Surrounding area : pitting on pressure Findings of inspection are confirmed Base: ulcer rest over the tendons and bone, no fixity Depth: 8mm Bleeding: no bleeds on touch Extends into the deeper structure Examination of regional lymphnodes : N o palpable lymphnodes

7. Local examination: of right foot Examination of vascular insufficiency: No varicose vein Anterior tibial and posterior tibial artery pulsation are palpable. Dorsalis pedis artery pulsation feeble Examination of Nerve lesion: Sensory loss around weight bearing area Absent ankle reflex

8. Diagnosis: Diabetic foot ulcer over the right planter aspect at head of the first metatarsal

9. Investigation: Study of discharge: culture & sensitivity, cytology X- ray of right foot Haemoglobin, ESR, total count and differential count Plasma glucose HbA1c Blood lipid profile Serum creatinine and blood urea Duplex ultrasound

10. Treatment: Debridement of dead tissue Off loading of pressure Broad spectrum antibiotics Drain collections of pus Daily ulcer cleaning and dressing Blood sugar control Wide fitting footwear Regular foot inspection