Keys To Addressing MRSA In The Diabetic Foot

Start Page: 64
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Author(s): 
Suhad Hadi, DPM, FACFAS, and Randy Garr, DPM

   Therefore, we decided to discontinue the antibiotics after consulting with the infectious disease team. The wound continued to improve and the patient progressed to weightbearing activities with prescription shoe gear and bracing.

Case Study Two: When A Patient With Diabetes Presents With One Week Of Pain, Redness And Swelling To Her Left Foot

A 57-year-old female with a history of diabetes for 12 years presented with complaints of pain, redness and swelling of her left foot for a one-week duration. She noticed the foot starting to blister on top and presented to the clinic. The patient denies any trauma or puncture, and states she wears socks around the house. She does have numbness to her feet and does not always feel well. The patient has had a history of a “sore” to the foot before but it healed after she put an antibiotic ointment on it. She tried the same ointment with this episode but the foot has not responded. The patient noted that she soaks the foot in warm, soapy water and applies the antibiotic ointment each day. She admits her blood glucose levels fluctuate and are usually more on the high end, around 200 mg/dL.

   In addition to having diabetes for 12 years, she has hypertension and has been on dialysis for three years. The remainder of her social and past medical history is non-contributory.

   On examination, the patient has palpable posterior tibial, dorsalis pedis and popliteal pulses bilaterally. She has absent protective sensation per Semmes Weinstein monofilament testing. There is a hemorrhagic bullous lesion encompassing the dorsal forefoot, extending from the base of her toes two through five and extending to the midshaft of the metatarsals. There is erythema encompassing the dorsal and lateral left foot to the level of the heel. Plantar to the distal fourth interspace, she has a hemorrhagic hyperkeratotic lesion communicating with the dorsal bulla via the webspace and there is a 2 mm pinpoint opening. There is plantar erythema extending across the metatarsophalangeal joints with tenderness to palpation at these levels. The tenderness is greatest to the fourth and fifth metatarsal heads, and fourth interspace.

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