Dr. Anudeep Puvvula (Endocrinology) needs a second opinion on this medical case.
An 65 year old gentleman presented with blackish discolration of great toe and nail since 15days A/w Foul smelly pus discharge, non healing ulcer which is painless and surroundings edema. Non healing ulcer surround by callus on bilateral medial aspect of heel region. With Bilateral cellulitis. By occupation he is a bus conductor H/O Type 2 DM since 15 Year’s HTN since 10 year and DPN since 12 Year’s After detailed examination his Sugars are uncontrolled Dyslipidemia Acute kidney injury ABI is normal 1.0 TBI I couldn’t examine in this patient VPT reviled he has severe neuropathy in both legs But no deformity as such (no Neuroarthropathy) Ecg is normal So I diagnosed this case as Infective Gangrene of right Hallux Neuropathy ulcer over bilateral medial ascpect of heel region Callus over left plantar aspect of fore foot Treatment Debridement done Cefperazone+ Saulbactum inj intravenous started Statin, Aspirin and clopidogrel tablets started ACE inhibitors also started For sugar control premix insulin twice and OHA triple combination started..... Doctors please kindly suggest of anything else I need to change
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