Case presentation-

Diabetic foot
Patient details

• Name – Mr. Seene gowda

• Age -55yrs
• Sex – male
• Occupation- Farmer
• Religion – Hindu
• Residency– Sunkadkatte bangalore

Chief complaints –
Wound on right foot since 2 months
 History of presenting illness

• Patients gives history of trivial trauma while

working in the fields 2 months ago following
which he developed bleb of 2*2 cm on the
medial aspect of great toe which burst on its
own leading to a formation of ulcer. The ulcer
gradually increasing in size to involve the
whole dorsum of the feet. It was not
associated with pain.
• Patient gives history of fowl smelling greenish
discharge from the wound for which he went to
local doctor where he was undergoing regular
dressing. There was no improvement of the ulcer.
No h/o affecting joint movements.
• H/o pins and needles since 2 yrs on both feet and
palms. Patient gives h/o altered sensation of feet
since 3-4 months. He feels light and not able to
feel the ground.
• No h/o syncopal attacks, dizziness on standing,
nocturnal diarrhoea, gustatory sweating, early
satiety, bloating sensation after meals.
• No h/o nausea, vomiting , abdominal pain/
distension
• No h/o nervousness , palpitations , tremors
,sweating.
• No h/o intermittent claudication.
• No h/o blurring of vision
• No h/o chest pain, breathlessness
• No h/o pedal edema, puffiness of face.
 Past history-
• Patient is k/c/o DM type 2 since 15yrs. He is on T.
MF 500mg 1-0-1. He is not very compliant with
treatment and misses doses often. His last blood
sugar was measured more than 6month ago. He
says it was normal. No h/o previous
hospitalisation for diabetes.
• No h/o HTN, MI, asthma, TB, etc
• No h/o previous surgeries in past.
Family history- h/o DM type 2 in father. Mother
and other siblings are healthy.
• Personal history –
Appetite-normal
Diet-mixed
Sleep- Adequate
Bowel – regular, no faecal incontinence
Bladder – normal, no h/o urinary retention/
incontinence
Habits – h/o smoking present- 20cigarettes/ day
for 15yrs.15 pack years.
Summary
 GENERAL PHYSICAL EXAMINATION-
• Patient is moderately built and nourished,
concious, co-operative and oriented to time
,place and person.
• Weight- 65kg height- 170cm BMI- 23
No pallor, icterus, cyanosis, clubbing,
lymphadenopathy and edema.
 Vitals –

• BP- 130/80mmhg in supine position

124/70mmhg in standing ,
• PR-- 82min,regular rhytm, normal volume, no
radio-radial or radio femoral delay, other
peripheral pulses felt.
• TEMP- Afebrile
• RR- 14/min abdomino-thoracic.
 AIRWAY
• Mouth opening- >3 finger
• Malampatti- Class 2
• Neck movements- normal
• Temperomandibular joint - 1 finger
• Thyromental distance - 3 finger
• Teeth – normal
• Able to perform upper lip bite test
• Prayer sign –ve
• Palm print sign- not done.

SPINE
Normal intervertebral spaces well felt.
 LOCAL EXAMINATION-
of right foot
• INSPECTION- A large single ulcer about 12*15 cm
irregularly shaped located on dorsum of foot
from right great toe and extending to lateral
aspect of the foot.
Edge – edematous, erythematous, sloping edge
Floor- covered with slough and some patchy pale
granulation tissue.
Discharge –whitish pus surrounding area is shiny,
pigmented.
• PALPATION-
• Tenderness – non tender
• Edge – irregular, spreading
• Base- bone
• Depth – deep to bone
• Bleeding – does not bleed on touch
• Surrounding skin- shiny, not edematous , no
varicosities.
• Lymph nodes- no palpable lymph nodes in
inguinal area.
 Systemic examination
• CVS- S1 S2 heard, Apical impulse -5th (lt)ICS, on the
MCL .
• RS- normal vesicular breath sounds heard in all lung
fields, no adventitious sounds
• P/ A- soft, no tenderness, no hepatomegaly, no ascites,
BS- 1-2/ min
• CNS- HMF- normal memory, orientation, concentration
Motor – bulk, girth, power, tone- normal b/l
Reflexes- ankle jerk could not be elicited on both
sides, knee, biceps, triceps abdominal reflexes normal
bilaterally
Sensory – pain, touch and temperature
sensation were absent on plantar aspect of
both feet, normal in all other areas.
Vibration, proprioception could not be
appreciated on plantar aspect of both feet,
normal in all other areas.
Cranial nerves -intact
Cerebellar signs – absent
Fundoscopy – not done
 Provisional diagnosis
• Type 2 diabetis mellitus uncontrolled with b/l
symmetrical peripheral sensory motor
neuropathy without autonomic neuropathy
with non- healing ulcer on right dorsum of
foot.