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March 2002
Case submitted by Stephen M. Schleicher,
MD
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CASE:
48-year-old woman with type I (insulin-dependent) diabetes
mellitus has an ulceration on her big toe. Because the patient
has been unaware of its presence, she cannot say how long
she has had it. She also reports no symptoms related to the
affected site, including pain. Examination of the toe reveals
a well-demarcated, nonpurulent zone of denudation of the plantar
surface of the toe with evidence of granulation tissue. A
bulla is noted on the adjacent toe. The foot is cool to the
touch. Pinpricks over both lower extremities elicit no response.
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People with diabetes are prone
to foot problems. These may be related to anatomical deformities,
vascular insufficiency, and sensory neuropathy that diminishes
a person's pain and pressure thresholds. When ulcers develop,
patients may be unaware of their presence. Education regarding
good foot care is therefore a priority task. Once a foot lesion
has developed, patients must be careful to avoid applying any
pressure on it. D³bridement and oral antibiotic therapy may
also be necessary. |
Dr. Schleicher is director of the DermDx Centers for Dermatology
of Northeastern Pennsylvania and a clinical instructor of dermatology
at Graduate Hospital's City Line Campus in Philadelphia, Kings
College in Wilkes-Barre, and Beaver College in Glenside, Pennsylvania.
He is also a member of the EMERGENCY MEDICINE editorial board.
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