Case Profile: Diabetes Mellitus with Dermal Ulcer & Osteomyelitis

Author: Fred Kahn MD, FRCS (C)
Source: Meditech International Inc.


Diabetes Mellitus with Dermal Ulcer and Osteomyelitis


  • 60 year old appraiser
  • Diabetic since 1983
  • Amputation of 2nd toe (May 2006)
  • Subsequent development of ulcer with draining sinus
  • Treatment with antibiotics, analgesics, packing and daily dressing changes
  • Unable to work or ambulate
  • Severe pain and edema of forefoot with cyanosis and impending gangrene

Physical Examination on Presentation at Meditech Clinic

  • Deep infection pre-gangrenous status
  • Cyanosis, edema and tenderness of forefoot
  • Extensive dressings and packing in place
  • Wound draining copiously and severe odour noted

Treatment at Meditech Rehabilitation Clinic

  • Removal of packing and dressings
  • Wound left open
  • Cessation of all medications
  • Saline compresses
  • Laser treatment 3 times per week

Progress on the Above Regime

  • After 8 weeks, forefoot presents without edema and only minimal erythema
  • Good mobility of toes
  • Healing of wound almost complete
  • No drainage
  • No evidence of inflammation

Most Recent Status

  • Returned to normal activities
  • Complete healing of wound


  • Fig. I to III – Initial status; dry and packing removed
  • Fig. IV to VI – Intermediate stage
  • Fig. VII to IX – Foot warm, pink and wound almost completely healed


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