A 30-year-old male patient with type 1 diabetes diagnosed at the age of 11 years was admitted because of infected foot ulcers on his right hallux. He had a mild fever and a history of proliferative diabetic retinopa-thy and microalbuminuria. Diabetes control was poor (HBA1c: 9.5%). He reported a trauma to his left foot 2 months earlier when an object fell on his feet while working. A superficial ulcer had developed on the dorsal aspect of his right great toe; the ulcer had become infected because the patient felt no pain and therefore did not seek medical advice.
On examination, pedal pulses were normal. Severe peripheral neuropathy was found and the vibration perception threshold was 30 V in both feet. An infected right hallux with purulent discharge, necrotic tissue at the tip, and cellulitis were observed (Figure 8.19). A plain radiograph showed osteomyelitis involving both distal phalanges (Figure 8.20).
A culture of the pus revealed Pseudomans maltophila, Enterobacter cloacae and
anaerobes, and the patient was treated with ciprofloxacin and ampicillin-sulbactam for 2 weeks, based on the antibiogram. An amputation of the right great toe was undertaken due to persistent osteomyelitis.
Keywords: Hallux; osteomyelitis; amputation
Was this article helpful?
This guide will help millions of people understand this condition so that they can take control of their lives and make informed decisions. The ebook covers information on a vast number of different types of neuropathy. In addition, it will be a useful resource for their families, caregivers, and health care providers.