Complications of Diabetes Mellitus: Foot Ulcer
Summary: This article details a clinical case of a 58-year-old man with type 2 diabetes who developed a right great toe ulcer from ill-fitting shoes, progressing to deep infection, osteomyelitis, and below-knee amputation due to delayed recognition amid neuropathy and vascular issues. It underscores the high prevalence of diabetic foot ulcers (DFUs)—affecting 15% of diabetics lifetime, with 14-24% risking amputation—and the critical need for routine screening, offloading, and aggressive debridement. Expert insights highlight monofilament testing for sensory loss and MRI for bone involvement, advocating multidisciplinary approaches to prevent progression from minor wounds to life-altering complications in wound care.
Key Highlights:
- Case details: Ulcer started as a callus from pressure; neuropathy masked pain, allowing infection spread to bone, requiring antibiotics, debridement, and eventual amputation after failed revascularization.
- Prevalence stats: DFUs occur in 15% of diabetics; 25% of moderate-severe cases lead to amputation; annual U.S. cost exceeds $9 billion.
- Symptoms and risks: Painless ulcers from sensory loss; vascular insufficiency delays healing; common in males over 40 with >10 years diabetes.
- Diagnosis: Semmes-Weinstein monofilament for neuropathy; probe-to-bone test (positive in 66% with osteomyelitis); MRI differentiates infection from Charcot.
- Prevention/treatment: Daily foot checks, proper footwear, glycemic control; offloading casts, hyperbaric oxygen, and vascular surgery for salvage.
Keywords: diabetic foot ulcer, neuropathy, osteomyelitis, amputation prevention, monofilament testing