Diabetic Foot Ulcer
comprehensive care for Diabetic Foot Ulcer
55 y.o male diabetic long standing history of poor blood sugar control and excess weight.
Prior resection of his 5th metatarsal from infected ulceration and pathologic fracture. He presented with initial ulceration after being advised that amputation of his foot was the only treatment that would work.
The patients xray revealed marked neurotrophic bone changes that were indistinguishable from osteomyelitis (bone infection). He was sent for a high tech bone scan available at L. I. Jewish Medical Center-part of a study we are conducting to determine if the destruction to the bone was from diabetes or from infection. The results suggested neurotrophic bone changes or Charcot foot. A bone biopsy was performed at our office at three different sites and determined to be negative for infection.
The patient was placed in a pressure relief walking cast to limit weight on the ulcer site. His blood sugars were tightly controlled. The wound was debrided or cleaned surgically with a scalpel blade at weekly intervals. The photos shown are taken weekly. This ulcer was closed completely in 8 weeks using a platelet derived growth facor and good wound management.
The patient is currently weraing a patella bearing brace orthosis to limit weight on his right foot No amputation or bone surgery has been needed to date nor is any planned.
