** Before Image ** A 75 years old gentleman was admitted in Deenanath Hospital with a gruesome looking foot. His sugars were uncontrolled and the foot was having discharging sinuses, ulcers & foul smell.He was seen by a surgeon & undergoing daily dressing & Eusol bath prior to dressings.I requested the treating Physician if I can see the patient.Thanks to the step by step project through which I had been trained extensively about diabetic foot care. On history taking the patient was having Charcot foot for last 20-25 years. He was always having some or the other ulcer over the foot & the foot was mostly in dressings for these reasons. He had undergone skin grafting for the fascitis 10 years back. This time he developed discharging sinuses over the dorsum and big ulcers over the plantar surface for more than 3 months. On examination – he had neuropathic foot which bled on touch. X-Ray showed – Evidence of re-absorption of terminal phalanx of great toe, distal metatarsals and proximal phalanges of 2nd, 3rd and 4th toes proximally and distal metatarsal of 5th toe with soft tissue swelling and irregularity. Neuropathic joints with? infection. Some new bone formation is seen along first metatarsal bone. Doppler study showed – Mild atherosclerotic changes in calf arteries more in posterior tibial artery. Foot was badly distorted. Skin was severely macerated and dorsum had 2-3 infected discharging sinuses. Planter surface showed infected ulcers. He had interdigital fungal infectious. Lots of crust was seen over the toes. I never had seen such a bad foot before. I found it really challenging and started working up on it. He was already on antibiotics. I started him on oral as well as local antifungal agents. I stopped his Eusol bath and cleaned the wounds with normal saline and dried it with gauze. Daily dressing with callus removal as and when required did wonders to him.

** After Image ** Patient was asked to completely off load the foot and was discharged after 12-15 days. He came for regular follow ups and dressings. Need for complete off loading had to be reinforced again and again.To see his progress everyone was feeling so satisfied. After almost 3-4 months his foot is totally dry and ulcer free.He had been given special footwear.The patient is following regularly without any major problems for last one and half months.

** Before Image ** A 47 years old gentleman, diabetic for 10 years, came to the Deenanath Hospital with complaints of non healing ulcer for last 2 years over lateral aspect of the plantar surface of left foot. He was having this non healing ulcer for 2 years and was treated with debridements many times before. This time a crossed flap surgery was planned. The patient was actually referred to me for Diabetes & fitness for surgery & of course as I was showing interest in diabetic foot care. Patient was not willing for flap surgery but as he was told that this was the only chance to heal the ulcer, he agreed for that. He was also told that he had to be in bed for at least one month. It was a typically neuropathic foot with normal ABI. Other parameters ( biochemical) were normal except mildly raised BSLs.On exam of the ulcer it was an ulcer surrounded by a rim of thick callus. On probing the depth was around 3.5 cm & at periphery it was 3 cm all over. On pressing the wound small quantity of pus came out.I took a deep swab & sent for culture. Culture grew staph aureus and he was put on Augmentin. Doppler showed no significant occlusion. X-Ray showed no involvement of the bone. As per my training in the workshop I was sure that here surgery is not the answer to his problem but the overall education and off loading foot of the patient is much more important. He was admitted for Blood Sugar control. Debridement was done and daily dressings started. He was completely offloaded and ask to use crutches for toilet usage.

** After Image ** As the patient was not very keen for surgery so it was decided to give him one more chance and he agreed to do whatever would be suggested to him.In consultation with orthopaedician we developed a special plaster cast with rubber sole,so he could walk without pressure on the ulcer.He was discharged after 10 days and asked to come to OPD for dressings and callus removal. The need for offloading had to be reinforced again and again. He was given a cast to elevate the fore foot. The ulcer healed completely in 1 ½ months. He was given preventive footwear and for last 6 months he is totally ulcerfree.

** Before Image ** 50 years old man came for the diabetic foot camp organised at Deenanath Hospital on 29 th of May. He is a diabetic for last 10-15 years. Brought by his wife for bilateral great toe ulcers & thickened skin for more than 2 months. The patient himself looked least bothered about the problem as there was no pain. On examination Typically neuropathic feet with normal ABI. Other biochemical parameters were normal. On exam of feet, he has bilateral great toe ulcers. Bigger over right than left with thick callus formation around it. The right great toe showed clawing. The ulcer size over right great toe was 2.5 x 2.5 cm.There was pus at the base of the rt great toe nail. He was admitted for complete off loading & calluses were removed. A scrapping was taken from the ulcer for culture & sensitivity which did not grew any organism.

** After Image ** Daily dressings with normal saline & Betadine & of course off loading did wonders in 15 days. He is a showing good recovery. He has been discharged and asked to dress the wound with PDGF. The need for off loading is reinforced again and again. He has been referred to Dr. S. Jain for preventive footwear .

This is Infrared Thermometer

Diabetic Foot Wear

Diabetic Foot Wear

Diabetic Foot Wear

Diabetic Foot Wear

Diabetic Foot Wear

Diabetic Foot Wear