Evaluation Of A Person With An Acute Diabetic Foot Problem

In the following case study, the author will discuss the issues surrounding a seventy-year-old female with a chronic neuropathic ulcer on the sole of her right foot and the rationale and implications of

This patient has athlete’s foot that has transmitted to his hand. This is a fungal infection caused by tineas, a cutaneous mycoses (22).

I was just two weeks into my internal medicine rotation at Suez Canal University in Egypt, when I encountered a case that I still remember to this day. Ms. Rafat was an elderly diabetic patient that came into our clinic complaining of a persistent wound on the sole of her foot. Upon removing her boots, her complaint turned out to be a foot ulcer with an infection extending to the first and second metatarsal bones .Unfortunately for her, we had to break the news to her and her family that her foot would need amputation. Ms. Rafat was understandably upset but took the news in stride. Following up on her case, I learned that after the surgery, the blood flow to her leg became increasingly poor and she had to return to have a below the knee amputation. Ms. Rafat ended up dying of pulmonary embolism as a complication of her second surgery. This case stayed with me not only because it

John is in his early forties and has had Type 2 Diabetes for 8 years. When he was first diagnosed, he was offered a diet sheet and advice from his doctor to introduce physical exercise into his life. John is a manual worker and feels he doesn’t need to exercise as he keeps active most of the day. He gave up smoking and drinking alcohol, but after 3 months his blood glucose level was still above normal and was prescribed medication. Eight years later, he now uses insulin to control his blood glucose levels and is a non-smoker. He was admitted to hospital following a road traffic accident which resulted in an operation on his foot which had sustained multiple injuries. The wound was very slow healing and intravenous antibiotics were prescribed.

HISTORY AND PHYSICAL EXAMINATION_______________________ Patient Name: Chapman Robert Kinsey Patient ID: 110589 Room No.: 322-B Date of Admission: 23 February ---Admitting Physician: Martha C. Eaton, MD, Geriatrics Chief Complaint: Admitted from Dr. Max Hirsch’s office due to deep ulcer on left toe. Admitting Diagnoses 1. Severe peripheral vascular disease, status post deep ulcer on left toe. Rule out thrombolysis. The patient was admitted to a regular floor. Condition is serious. 2. ALLERGY TO PENICILLIN, which puts patient into anaphylactic shock. 3. Continue with home medications. DETAILS OF PRESENT ILLNESS: Mr. Kinsey is an 87-year-old white gentleman with history of (1) Chronic atrial fibrillation, on Coumadin. (2) Chronic deafness,

HISTORY OF PRESENT ILLNESS: This is a 53-year-old black individual a patient of Dr. Shelton, who has had diabetes for at least six months, but he thinks it has been longer than that. He says his last known blood sugar was in the 300’s. He presents in the ER today with a foot ulcer since January of this year. He

It is estimated that 387 million people, globally live with diabetes (Phillips & Mehl, 2015). According to Medical News Today [MNT], diabetes is a metabolic disorder; which causes patients to be extremely thirsty and produce a lot of urine. Diabetes arises due to high blood pressure, due to the body not being able to produce enough insulin or because the body does not respond well to high insulin levels (MNT, 2016). There are four types of diabetes; there is the pre-diabetic stage, type 1 diabetes, type 2 diabetes and gestational diabetes. In 2014, 29 million people died due to diabetes. This equates to 1 diabetic patient dying every seven seconds due to preventable complications (including complications affecting lower limbs) caused by diabetes. It is said that 20-40% of health care costs are spent on the treatment of lower limb complications due to diabetes. The risk of a diabetic patient developing a foot ulcer is 25% and foot ulcers account approximately 85% of lower limb amputations. Diabetic complications that affect lower limbs are caused by both type 1 and type 2 diabetes (Phillips & Mehl, 2015). It is said that the World Health Organization described diabetic foot syndrome as including all possible complications in relation to the feet of a diabetic patient. Diabetic foot syndrome is defined as the ulceration of the foot, from the ankle downwards. Causes of foot ulceration include peripheral sensory neuropathy, vascular disease (ischaemia) and infection

One afternoon a 67 year-old man presented to the emergency department of a small, rural hospital complaining of severe left leg and hip pain following a fall at home. The patient had no past history of falls. He had a history of impaired glucose intolerance, prostate cancer, hypercholesterolemia and hyperlipidemia. The patient’s current medications were atorvastatin and oxycodone for chronic back pain. The patient stated his pain was ten out of ten on a scale of one to ten with ten being the worst. The left leg appeared shorter than the right, edema was present in the calf, as was ecchymosis and he had limited range of motion. After an evaluation in triage by a registered nurse and a subsequent examination by the emergency department physician, a plan was established to sedate the patient using moderation sedation protocol and perform a manual reduction of the hip.

Diabetic Peripheral Neuropathy (DPN) is one of the most common microvascular complications in diabetes and can result in foot ulceration, ampuation and an impaired quality of life(Carrington AL, et al 2002,Boulton AJ,et al 2004). The reported prevalence of diabetic peripheral neuropathy ranges from 16% to as high as 66%2 and its prevelance is believed to increase with the duration of diabetes and poor glucose control.(Boulton AJ.et al 2000) It’s accounts for 50–75% of non-traumatic amputations in diabetic patients.(Holzer SE, et al 1998, Boulton AJM, 1998,Malay DS, et al 2006)

Both clinicians who are enquiring clinical questions and researchers who are conducting in-depth searches for systematic reviews come across a few

Today, I followed Dr. Koch in podiatry. For the first patient we saw, the patient already had cotton balls on their feet, which I thought Dr. Koch’s assistants had probably already looked at the patient. Anyway, the patient had an appointment with Dr. Koch about 2 months ago and was told to wear diabetic shoes when walking. As she and Dr. Koch talked, Dr. Koch removed one of the cotton balls and there was a big sore on the patient's foot. Dr. Koch then asked the patient if they had diabetic shoes, and if so, how often did they wear them. The patient answered by saying she does but only wore the shoes for about fifty percent of the time. Dr. Koch told the patient she need to have the shoes on the entire time, otherwise she’ll keep getting sores

Osteomyelitis is a broad and debilitating disease typically triggered by a variety of conditions. Osteomyelitis starts off as inflammation seen within bone and bone marrow that can quickly progress into a large, subclassified infection. The length of time the infection has been present in the body and whether or not there is a pus formation or increased density among the infected bone is commonly used to classify severity. Pyrogenic bacteria or mycobacteria systematically attack the route and anatomic location of the infection evolving acute conditions into chronic ones. “Staphylococcus Aureus is a gram-positive, round shaped, non-mobile cocci typically found in clusters inside these wounds. Staphylococcus Aureus is one of the most common causes of infections after injury or surgery and affects nearly 500,000 patients in hospitals each year. Staphylococcus Aureus belongs to the family Staphylcoccaceae and survives by affecting all known mammalian species including humans” (www.news-medical.net). Osteomyelitis can start in one area of the body while spreading through the blood stream into other bone regions. Typical treatment options for Osteomyelitis includes antibiotics, removal of

In this case the level of prevention used, when implementing the diabetic foot care teaching, is tertiary prevention. “This intervention begins once the disease if obvious: the aim is to interrupt the course of the disease,

A 53-year-old man had just had prosthetic joints cemented into place without added antibiotics to fight infection. For 3 months after the surgery he was doing fine until he found he had a dental infection and didn’t seem to think anything of it, so he did not go to the dentist to fix it. Soon aftter he suffered from chills without fever, swelling, pain, an unusual warming sensation, and irritation over the left knee and had a hard time

Foot injuries are very common in athletics as well as in everyday life. It’s very debilitating to have a foot injury since we use our feet in all of our daily activities. Research published in "Medicine and Science in Sports and Exercise” indicates that the average adult takes between 5,000 to 7,000 steps a day. Some sports require the most dedicated athletes spend multiple hours a day pounding their feet on the turf or pavement. Most injuries that occur in the foot require a person to try and stay off of it or completely immobilize it. Since this is very difficult for a person to do, a large percentage of foot injuries often have a very high chance of reoccurring. The severity of some injuries that can be deceiving as well. Often times a nagging pain is ignored and eventually becomes a much bigger problem.