Always consider a differential and a multidisciplinary approach to the foot
Published Date: 18th April 2021
Publication Authors: Sullivan H, Furlong NJ, Pendlebury H
Conference Abstract
The Multidisciplinary Diabetes Foot Clinic manages patients primarily with neuropathic or neuroischaemic ulcers or Charcot arthropathy. The following are cases that did not fit the classical picture, requiring involvement in the wider multidisciplinary team to diagnose and treat the underlying condition.
A 76-year-old gentleman with persistent bilateral plantar hypervascular ulcerations, which failed to improve despite regular podiatric review, debridement and wound care, due to the hypervascular nature he was referred to dermatology and a diagnosis of verruca infection was made, treated with cryotherapy and went on to heal.
A 74-year-old lady with a persistent right plantar ulcer which was painful and failed to heal over 5 months. Imaging excluded foreign bodies. She was referred to dermatology, a biopsy showed Squamous Cell carcinoma, which healed following full excision.
An 89-year-old woman with dry necrosis to her toes but biphasic pulses on Doppler, due to this she was referred to rheumatology and diagnosed with systemic sclerosis and commenced on iloprost.
Finally, a 65-year-old with a left 3rd plantar ulcer and warmth and swelling to his foot, initially diagnosed as Charcot arthropathy, however imaging indicated possible erosive arthopathy, blood ruled out gout and subsequently he was diagnosis with avascular necrosis. He stopped smoking, and within 4 weeks the clinical signs subsided.
This case series demonstrates the need to always consider a differential diagnosis, when the clinical picture does not quite add up.
Sullivan, HR; Pendlebury, H; Furlong, N. (2021). Always consider a differential and a multidisciplinary approach to the foot. Diabetic Medicine. 38 (S1), 40