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Onlinedoc
Onlinedoc, General Physician
Category: Health
Satisfied Customers: 2838
Experience:  B.A.M.S with experience in Medicine,Ayurveda, Integrative, CAM
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A 60 year-old female patient presents in clinic with a suspected

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A 60 year-old female patient presents in clinic with a suspected ulcer on her left big toe. She reveals that she is a type II diabetic and has been for over 15 years. She complains of having cold, painful feet. Upon examination, the patient has very cold, very red feet. Her left big toe is especially swollen, with an area of blackened callus on the tip of the toe overlying a suspected ulcer. The toe is very painful. The patient recently went to her diabetic nurse who suspects that she may have osteomyelitis in the distal phalanx of her left hallux. Describe treatment process for this patient, from the history taking through to treatment, management plan and possible referral?

Be sure to include in your answer:
• What tests would be carried out, why they would be done and what the results indicate
• What the treatment options for this patient would be
• Recognition of osteomyelitis
• To whom and when they would be referred.

Hi,

Is her diabetes under control?

Any history of localised trauma?

Any history of prolonged hours of standing or sitting in same position?

Any associated bleeding?

Customer: replied 4 years ago.

This is an essay question that I'm struggling with on a foot healthcare professional course. I believe this question has been posed before but obviously I could not view. So in order to address I would say that after 15 years the diabetes is under control - no localised trama or bleeding and profession office worker. Thanks so much I have a big deadline to meet which is a further 5 essays Hilary

Hi,

Investigations-

Blood work like CBC,ESR,Lipid panel,Renal function test,Blood sugar,HbA1c.

She needs ultrasound studies of her lower extremities-dopplers of arterial and venous flow as this might be due to very poor circulation.

An Xray of the foot-toe specifically to rule out osteo. This will likely be non diagnostic so a bone scan or CT of the foot would tell.

An ESR might add weight to the osteo diagnosis if it is very high.

Treatment-

Wound care should be done

In case of infection, broad spectrum antibiotics can be given.

IV fluids can be given as well.

In case of high blood sugar levels,short acting insulin can be advised.

Tetanus toxoid shot should be updated(if the patient has not given shot since last 5 years) to prevent any further complications.

Referral

A consult with podiatry or with Orthopedics should be ordered if osteo is confirmed as surgery might be indicated.

 

 

 

Hope this helps.
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Onlinedoc and 2 other Health Specialists are ready to help you
Customer: replied 4 years ago.

Thank you very much for sharing your expertise - these bullet points will certainly help me with my essay

Hi,

You are most welcome.

 

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