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Infection in the diabetic foot
J H Calhoun1, J T Mader, J P Sanford
1Division of Orthopedic Surgery, University of Texas Medical Branch, Galveston.
Hospital Practice (Office Ed.)
|March 30, 1992
Summary
A diabetic patient developed chronic toe infection after minor trauma. Imaging confirmed osteomyelitis, highlighting the risk of infection in diabetic foot complications.
Area of Science:
- Podiatric Medicine
- Diabetology
- Infectious Diseases
Background:
- A 56-year-old woman with a 15-year history of diabetes mellitus, insulin-dependent for five years, presented with a chronic right first toe infection.
- The infection followed a minor toe injury sustained one month prior, resulting in bruising, a small cut, and subsequent serous to purulent drainage.
Observation:
- Physical examination revealed a reddened, draining toe with no signs of systemic infection or necrotizing fasciitis.
- The patient exhibited decreased foot sensation, slow capillary refill, and reduced transcutaneous oxygen tension (20 mm Hg).
- Laboratory results showed elevated serum glucose (250 mg/dL) and creatinine (1.5 mg/dL).
Findings:
- X-rays indicated diffuse osteomyelitis of the distal phalanx of the great toe.
- Technetium and indium scans demonstrated positive, localized increased uptake corresponding to the radiographic changes.
- The diagnostic findings confirmed chronic osteomyelitis in the diabetic patient's great toe.
Implications:
- This case underscores the critical risk of severe foot infections, including osteomyelitis, in patients with diabetes mellitus, even after seemingly minor trauma.
- Early and accurate diagnosis using imaging modalities like X-rays and nuclear scans is crucial for effective management of diabetic foot infections.
- Prompt hospitalization and treatment are indicated for patients presenting with signs and symptoms suggestive of osteomyelitis, particularly those with underlying diabetes.