A 74-year-old male patient with type 2 diabetes attended the outpatient diabetic foot clinic because of a chronic painless ulcer on the medial aspect of the right first metatarsal head (Figure 8.32). The ulcer developed over a bunion deformity, and had persisted for 10 months.
On examination, the peripheral pulses were palpable and the patient had severe peripheral neuropathy. He could not feel pain, light touch, vibration or 5.07 monofilaments. The vibration perception threshold was above 50 V in both feet. After debride-ment, the underlying bone could be felt by means of a sterile probe. A plain radiograph revealed osteomyelitis of the first metatarsal head and the proximal phalanx of the right great toe (Figure 8.33). The patient sustained a first ray amputation.
Chronic osteomyelitis needs surgical removal of the infected bone. However, recent data suggest that prolonged treatment with antibiotics (for 1 or 2 years) may eradicate chronic osteomyelitis. However, no consensus on this issue exists at present.
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