Concluded Case

A known diabetic woman, aged 36 years reported painless ulcers over the ball of the first toe and near the heel. Edges are punched out, granulation tissue is pale. Surrounding skin has become fibrotic. what is the diagnosis? How do you manage the condition?

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Concluded answer

These are Neurotrophic ulcers. Thoroughly debridement is required. Daily dressing with superoxide solution. Control of DM, intact vascularity to peripheral tissues & increasing sensation will be helpful with proper foot care & footwear. Methylcobalamin +Pregabalin +Nortryptiline +ALA +Benfothiamine +Inositol +EPA +DHA OD to improve sensation. Cilostazole to improve vascularity. Better to switch to insulin as it is neurotropic in nature & helps in improving the sensation. Usually these are not infected & no antibiotics required. If there is infection, then only antibiotics. @Dr. Shrikant Bhoyar Sir, your opinion please.

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Diabetic ulcer.. Diabetic neuropathy involved.

Diabetic foot Ulcer Neuro Tropic Ulcer.

Diabetic foot Trophic ulcers Painless suggest peripheral neuropathy hence neurotrophic ulcer Paleness in base also hints vasculopathy Thus despite of good control of sugar vary difficult to heal Still try should be given Offload of weight on affected parts by modified foot wears Debridement with regular dressing with bactigrass insulin infiltration Coverage of broadspectrum antibiotics Ifwound is dehrading without any healthy sign than Amputation will remain last choice

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@Diabetic ulcer. Debride the ulcer and use flap to cover the ulcer.

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DD Diabetic ulcer Trophic ulcer Colour Doppler study of vessels of lower limbs Tissue for HPE Xray foot AP+Lat Debridement of wound ASD with NS & Betadine H2O2 Mupirocin ointment to apply locally Antioxidant Control of Blood Sugar NSAIDS if needed Antiinflammatary Antibiotics Care of foot

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AGREE. WITH @ DR. KUTE ANKUSH. JI

Diabetic foot ulcer

IT'S A CASE OF.. * DIABETIC ULCERS.. * TROPHIC ULCERS.. * VASCULONEUROPATHIC ULCER.. NEEDS CLINICOPATHOLOGICALLY EVALUATION WITH.. BLOOD CBC CT BT PT.. URINE ROUTINE.. BSR HBA1C.. COLOUR DOPLER STUDY.. TISSUE HISTOPATHOLOGICAL STUDY.. MEANWHILE TREAT WITH.. CLEANING DEBRIDEMENT AND DRESSING WITH ANTISEPTIC ANTIBIOTICS OINTMENT MUPIROCIN.. ORALLY..ANTIBIOTICS WITH NSAID ..AS PER REQUIREMENT..

Tnx a lot Dr Dinesh Gupta
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Diabetic ulcer Debride the ulcer and use a flap to cover the ulcer.

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Arterial doppler both lower limbs. Xray ap and oblique View of foot. Probe to see if bone is involved or not. Plaster cast and dressing

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