Abstract
Diabetic foot osteomyelitis is an advanced complication of diabetic foot infection which can increase the risk of amputation. This report discusses a case of a 50-year-old female with a wound on the thumb of her left foot that became more swollen with a bluish red color within one month. The patient delayed her treatment due to the COVID-19 pandemic. She has had diabetes and hypertension for 20 years which is uncontrolled. Physical examination showed a sausage toe digiti 1 left pedis with wound 4 x 2 cm with purulent discharge, Probe to Bone (PTB) positive. Laboratory and x-ray examination showed leukocytosis, increased erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP), glucose level 415 mg/dL, and HbA1c 13.1%, with destruction and fragmentation in first toe bone of the left foot. Because she refused minor surgery, the wound was treated regularly by removing infected bone fragments and giving intravenous (IV) antibiotics for four weeks. For glucose level control, continuous IV insulin was given with subcutaneous basal-bolus insulin, then continued by outpatient care with oral antibiotics. After seven weeks, manifestations of infection improved, the wound area was reduced, and antibiotics were discontinued, but wound care was continued. Metabolic control along with long-term antibiotics and wound care for diabetic foot osteomyelitis can be used as an alternative to surgery
References
1. Lipsky BA, Senneville E, Abbas Z, Sanchez JA, Diggle M, Embil JM, et al. Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36(Suppl 1):e3280. 2. van Asten SAV, Peters E, Xi Y, Lavery L. The role of biomarkers to diagnose diabetic foot osteomyelitis. A meta analysis. Curr Diab Rev. 2016;12(4):396-402. 3. Giurato L, Meloni M, Izzo V, Uccioli L. Osteomielitis in diabetic foot: a comprehensive overview. World J Diabetes. 2017;8(4):135-42. 4. Tone A, Nguyen S, Devemy F, Tapolinski H, Valette M, Cazaubiel M. Six-week versus twelve-week antibiotik therapy for nonsurgically treated diabetic foot osteomielitis: a multicenter open-label controlled randomized study. Diabetes Car. 2015;38:302-7. 5. Mayo Clinic. C-reactive protein test [Internet]. Mayo Foundation for Medical Education and Research (MFMER) [accessed 2 July 2020]. Available from: https://www.mayoclinic.org/tests-procedures/creactive-protein-test/about/pac-20385228#:~:text=For%20a%20 standard%20CRP%20test,testing%20to%20determine%20the%20 cause. 6. Farkas J. PulmCrit: neutrophil-lymphocyte ratio (NLR): free upgrade to your wbc [Internet]. EMCrit Project; 21 May 2019 [accessed 2 July 2020]. Available from: https://emcrit.org/pulmcrit/nlr/ 7. Everett E, Mathioudakis N. Update on management of diabetic foot ulcers. Ann N Y Acad Sci. 2018;1411(1):153–65. 8. Chang JW, Heo W, Choi M, Lee J. The appropriate management algorithm for diabetic foot: a single-center retrospective study over 12 years. Medicine (Baltimore). 2018;97(27):e11454. 9. Bader M. Diabetic foot infection. Am Fam Physicians. 2008;78(1):71- 9. 10. Alvarez J, Gasparrini M, Tamara Y, Hernandez F, Mazzoni L, Giampiert F. The composition and biological activity of honey: a focus on Manuka honey. Foods. 2014;3:420-32. 11. Shodja M, Knutsen R, Cao J, Oda K, Beeson L, Fraser G, et al. Effects of glycosylated hemoglobin levels on neutrophilic phagocytic function. Jacobs J Diabetes Endocrinol. 2017;8(2):1-8. 12. Baltzis D, Eleftheriadou I, Veves A. Pathogenesis and treatment of impaired wound healing in diabetes mellitus: new insights. Adv Ther. 2014;31(8):817-36. 13. Fasseha B, Abularrange C, Hines K, Sherman R, Frost P, Langan S, et al. Association of hemoglobin A1c and wound healing in diabetic foot ulcers. Diabetes Care. 2018;41:1478-84. 14. Game F, Jeffcoate W. Primarily non-surgical management of osteomyelitis of the foot in diabetes. Diabetologia. 2008;51:962-7.
Recommended Citation
Yunir, Em and Aziza, Yully Astika Nugrahayning
(2021)
"Non-Operative Management of Diabetic Foot Osteomyelitis: ACase Report,"
Jurnal Penyakit Dalam Indonesia: Vol. 8:
Iss.
2, Article 6.
DOI: 10.7454/jpdi.v8i2.471
Available at:
https://scholarhub.ui.ac.id/jpdi/vol8/iss2/6