Transform diabetic foot
Courtesy of Helen Reid Advanced Podiatrist - Diabetes, Gloucestershire Health and Care NHS Foundation Trust, UK
75-year-old male with a history of type 2 diabetes and hypertension. The patient was referred to the multi disciplinary diabetic foot clinic (MDFT) following presentation in the community with significant ulcer & infection to his right foot.
On examination his right foot had multiple communicating deep plantar wounds extending towards 5th toe with exposed fascia and tendon. The patient was diagnosed with a neuropathic diabetic foot ulcer with osteomyelitis.
A swab tested positive for Proteus Mirabilis sensitive to amoxicillin, gentamicin and ciprofloxacin. STIMULAN beads mixed with gentamicin were inserted into the plantar wound.
4 days after the initial application of STIMULAN to the plantar wound the infection had spread; the 5th toe had become dark in colour with associated erythema and swelling of the foot and lower leg. A significant amount of purulent discharge was released from the interdigital space between the 4th and 5th toes. The patient was strongly advised that admission would be more appropriate for on-going treatment but the patient declined due to a negative previous experience. Oral co-amoxiclav was used alongside a second application of STIMULAN to the wound between the 4th and 5th toes to manage the infection. As a consequence of the infection severity, he had twice weekly follow-up with the podiatry team. 11 days later there was significant improvement.
After 4.5 months the wounds were fully healed. The patient was very relieved he avoided hospital admission.
The clinician commented that STIMULAN was straightforward to mix & administer in outpatient setting. Together with systemic antibiotic treatment, hospital admission was avoided and successful limb preservation achieved.
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