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Suggest Treatment For Diabetic Foot Infection
Question: Hi,
My father is 60 years old and he is diabetic. He got a wound in his leg near his little finger and it is stagnant in size.
It is not growing. It looks white. But, from few days pus is coming from it. Doctor advised for dressing. After dressing, lot of pus comes out and the bandage itself looks brown. The pus is like water. My father has pain most of the time and he has lot of discomfort because of this. Kindly, let me know if this wound heals. Also, any complications involved in this.
He has brought down his sugar level to a great extent. Currently, FBS is 170 mg/dl and PPBS is 258 mg/dl.
Please kindly let me know if anything serious.
Thank you,
Concerned daughter
My father is 60 years old and he is diabetic. He got a wound in his leg near his little finger and it is stagnant in size.
It is not growing. It looks white. But, from few days pus is coming from it. Doctor advised for dressing. After dressing, lot of pus comes out and the bandage itself looks brown. The pus is like water. My father has pain most of the time and he has lot of discomfort because of this. Kindly, let me know if this wound heals. Also, any complications involved in this.
He has brought down his sugar level to a great extent. Currently, FBS is 170 mg/dl and PPBS is 258 mg/dl.
Please kindly let me know if anything serious.
Thank you,
Concerned daughter
Brief Answer:
As mentioned below
Detailed Answer:
Hello XXXX,
Thank you for writing to HCM. Noted your concern.
There are a few things I would like to know before giving you my opinion on your father. How did the wound start? Was there any trauma like a shoe bite? When did the ulcer appear - is it few days or weeks? Does he have chills or fever? Is he resting enough or does he walk around? Is the pain severe in the night not letting him sleep? Has he ever smoked? Does he have any other illness like hypertension or cholesterol or heart conditions? What antibiotic is he on now? What is the dressing material he is using? It would be very useful if you could post a picture of the area.
For any wound to heal there are a few essential things. The blood glucose levels should be well controlled. In his case, though it has improved it is not ideal. The body defenses works best after 3 weeks of good glycemic control. Secondly, there should be enough blood to the area. The pulse in the feet should be well felt. Thirdly, we need to tackle the infection with appropriate antibiotics based on culture of the pus/tissue and use dressings that is right for the wound. Fourthly and most importantly, contrary to the popular opinion that patients with diabetic foot should walk the concept of 'offloading' is accepted and advised where by the patient needs to rest and use a walker until the wound heals. Some patients will need surgery where infected tissues are removed thus enabling and enhancing the wound healing.
I will surely do my best to give you the right advise. I hope you can get back to me with the queries I mentioned above.
Do not worry. There is a solution even to the hardest problem.
Warm regards
Dr XXXXXXX
As mentioned below
Detailed Answer:
Hello XXXX,
Thank you for writing to HCM. Noted your concern.
There are a few things I would like to know before giving you my opinion on your father. How did the wound start? Was there any trauma like a shoe bite? When did the ulcer appear - is it few days or weeks? Does he have chills or fever? Is he resting enough or does he walk around? Is the pain severe in the night not letting him sleep? Has he ever smoked? Does he have any other illness like hypertension or cholesterol or heart conditions? What antibiotic is he on now? What is the dressing material he is using? It would be very useful if you could post a picture of the area.
For any wound to heal there are a few essential things. The blood glucose levels should be well controlled. In his case, though it has improved it is not ideal. The body defenses works best after 3 weeks of good glycemic control. Secondly, there should be enough blood to the area. The pulse in the feet should be well felt. Thirdly, we need to tackle the infection with appropriate antibiotics based on culture of the pus/tissue and use dressings that is right for the wound. Fourthly and most importantly, contrary to the popular opinion that patients with diabetic foot should walk the concept of 'offloading' is accepted and advised where by the patient needs to rest and use a walker until the wound heals. Some patients will need surgery where infected tissues are removed thus enabling and enhancing the wound healing.
I will surely do my best to give you the right advise. I hope you can get back to me with the queries I mentioned above.
Do not worry. There is a solution even to the hardest problem.
Warm regards
Dr XXXXXXX
Above answer was peer-reviewed by :
Dr. Sonia Raina
How did the wound start?
He used to go by his scooter. Once, on the road, the scooter stand his his foot and from that time the wound started.
When did the ulcer appear - is it few days or weeks?
Few days.
Does he have chills or fever?
He had fever one week before. He took medicines as per doctor's advice. Now, for the past one week there is no fever.
Is he resting enough or does he walk around?
He is resting but he does walk and not everytime he takes rest. He does his usual work also.
Is the pain severe in the night not letting him sleep?
Yes, His pain is more in the night.
Has he ever smoked?
Yes, He has smoked. But, he has stopped it one year before.
Does he have any other illness like hypertension or cholesterol or heart conditions?
No.
What antibiotic is he on now? What is the dressing material he is using?
I will check and give you the details.
Meanwhile, based on the above input, can you please tell me is there any serious implications? I am really worried.
I would take a photo of it and send it to you.
Kindly, let me know if something has to be taken care of. Thank you.
He used to go by his scooter. Once, on the road, the scooter stand his his foot and from that time the wound started.
When did the ulcer appear - is it few days or weeks?
Few days.
Does he have chills or fever?
He had fever one week before. He took medicines as per doctor's advice. Now, for the past one week there is no fever.
Is he resting enough or does he walk around?
He is resting but he does walk and not everytime he takes rest. He does his usual work also.
Is the pain severe in the night not letting him sleep?
Yes, His pain is more in the night.
Has he ever smoked?
Yes, He has smoked. But, he has stopped it one year before.
Does he have any other illness like hypertension or cholesterol or heart conditions?
No.
What antibiotic is he on now? What is the dressing material he is using?
I will check and give you the details.
Meanwhile, based on the above input, can you please tell me is there any serious implications? I am really worried.
I would take a photo of it and send it to you.
Kindly, let me know if something has to be taken care of. Thank you.
Brief Answer:
Noted
Detailed Answer:
Thanks for the prompt and clear reply. Awaiting the photograph of the area and the details of the antibiotics.
Well, from what you mentioned I feel you need to put him on a culture specific antibiotic (pus sample can be used) for atleast 2 weeks. Please ask him to take complete rest and walking can worsen the clinical scenario. It would be nice if you can get a doctor to assess his vascularity (blood supply) to his feet. The pain being worse in the night along with such a trivial trauma (hit on the scooter stand) and a past history of smoking suggests that he has a slight decrease in blood supply. We can confirm that only with an examination. A test that can be done would be an arterial doppler to the leg which can tell that in detail.
I do not mean to scare you but then every diabetic foot infection is a serious one until it heals. We need to be very vigilant about it. His medications for diabetes have to be optimised. Insulin is a good choice in this setting as it can achieve rapid control which is needed for wound healing.
Do not worry. As of now, let him rest 100%, give him culture specific antibiotics and let us do a vascular assessment with an arterial doppler.
I will get back to you once I hear about the antibiotics he used and the dressing material he is using.
Warm regards
Noted
Detailed Answer:
Thanks for the prompt and clear reply. Awaiting the photograph of the area and the details of the antibiotics.
Well, from what you mentioned I feel you need to put him on a culture specific antibiotic (pus sample can be used) for atleast 2 weeks. Please ask him to take complete rest and walking can worsen the clinical scenario. It would be nice if you can get a doctor to assess his vascularity (blood supply) to his feet. The pain being worse in the night along with such a trivial trauma (hit on the scooter stand) and a past history of smoking suggests that he has a slight decrease in blood supply. We can confirm that only with an examination. A test that can be done would be an arterial doppler to the leg which can tell that in detail.
I do not mean to scare you but then every diabetic foot infection is a serious one until it heals. We need to be very vigilant about it. His medications for diabetes have to be optimised. Insulin is a good choice in this setting as it can achieve rapid control which is needed for wound healing.
Do not worry. As of now, let him rest 100%, give him culture specific antibiotics and let us do a vascular assessment with an arterial doppler.
I will get back to you once I hear about the antibiotics he used and the dressing material he is using.
Warm regards
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Answered by
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