Diabetic Foot Osteomyelitis - Is Surgery Best?

PRESENT Podiatry Online CME & Conferences 8/26/18, 9)52 PM
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Diabetic Foot Osteomyelitis - Is Surgery Best?
Pre-Test
1. * A 56 year old male presents to the hospital with complaints of left foot pain and swelling for 3
days. He states that he does have two ulcerations on the bottom of his foot which have not been
managed by any physician. He states that he walks around with work boots and insulated socks
daily. The patient denies any puncture wounds to his feet. He states that he noticed some “milky”
drainage from his left foot and it started to become malodorous.
CME Progress
ROS
General: + fevers, + chills, negative fatigue
CV: Negative chest pain, negative palpitations
Resp: Negative shortness of breath
GI: Negative abdominal pain, negative diarrhea, negative vomiting
GU: Negative polyuria and polydipsia
1. MSK: Per HPI
A 56 year old male presents to the hospital with complaints of left foot pain and swelling for 3
days. He states that he does have two ulcerations on the bottom of his foot which have not been
PMHx: DM2, HTN
managed by any physician. He states that he walks around with work boots and insulated socks
Meds: Insulin
daily. The patient denies any puncture wounds to his feet. He states that he noticed some “milky”
Allergies: NKDA
drainage from his left foot and it started to become malodorous.
Sochx: Denies smoking, occasional alcohol, and is a construction worker
*
ROS
Vitals:
General: + fevers, + chills, negative fatigue
Temperature- 99.8°
CV: Negative chest pain, negative palpitations
HR- 110
Resp: Negative shortness of breath
RR: 21
GI: Negative abdominal pain, negative diarrhea, negative vomiting
GU: Negative polyuria and polydipsia
https://podiatry.com/lecturehall/wizard/4920 Page 1 of 6
MSK: Per HPI
PMHx: DM2, HTN

Physical Examination:
Vascular: DP/PT ¼ bilaterally, significant edema on lateral dorsal aspect of the left foot
Neurological: Sensation to light touch intact, diminished protective sensation, absent vibratory
sensation
MSK: Muscle strength 5/5 in all four quadrants of the foot b/l, Pes cavus foot type bilaterally
Derm: Ulceration sub-5th metatarsal head left foot, measuring approximately 1.5 x 2.2 x 4.5 cm,
probes to bone with tracking proximally on the dorsal aspect of the foot. Ulceration sub-1st
metatarsal head left foot measuring approximately 1.3 x 0.7 x 0.2 cm, does not probe to bone.
Serous bulla on the dorsal aspect of the lateral left foot.
Physical Examination:
Vascular: DP/PT ¼ bilaterally, significant edema on lateral dorsal aspect of the left foot
Neurological: Sensation to light touch intact, diminished protective sensation, absent vibratory
sensation
MSK: Muscle strength 5/5 in all four quadrants of the foot b/l, Pes cavus foot type bilaterally
Derm: Ulceration sub-5th metatarsal head left foot, measuring approximately 1.5 x 2.2 x 4.5 cm,
probes to bone with tracking proximally on the dorsal aspect of the foot. Ulceration sub-1st
metatarsal head left foot measuring approximately 1.3 x 0.7 x 0.2 cm, does not probe to bone.
Serous bulla on the dorsal aspect of the lateral left foot.
Labs:
WBC- 22,000
HbA1c- 9.8
Na- 125 mEq/L
Imaging:
HbA1c- 9.8
Na- 125 mEq/L
Imaging:
MRI: sagittal images of the left foot reveals hypo intensity of the soft tissue on the dorsal aspect of
the fifth metatarsal.
X-Ray left foot (3 views): There is evidence of soft tissue emphysema in the lateral aspect of the
foot with osteomyelitis changes to the fifth metatarsal head.
Which of the following is correct when considering when a surgeon should operative on a diabetic
foot infection?
A. When the infection is potentially life-threatening, surgery is required
B. Surgery reduces pressure in the aﬀected compartments of the foot

MRI: sagittal images of the left foot reveals hypo intensity of the soft tissue on the dorsal aspect of
the fifth metatarsal.
X-Ray left foot (3 views): There is evidence of soft tissue emphysema in the lateral aspect of the
foot with osteomyelitis changes to the fifth metatarsal head.
C. Early surgical treatment may reduce the need for
D. All of the above are true
2. * Which of the following best describes the basis of surgical treatment of diabetic foot infections?
A. Surgically open all compartments of the foot for all infections
B. It is best to make as little of an incision as possible to allow for the patient to heal quicker
C. Early surgical treatment may reduce the need for
C. Detecting the path of which the infection has traveled and opening up a tract from the entrance
D. All until
point of thethe
above are true
end point.
D. None of the above

2.
Which of the following best describes the basis of surgical treatment of diabetic foot infections?
A. Surgically open all compartments of the foot for all infections

3. * True or False: The above patient may be treated with antibiotics alone, may be discharged from
the hospital and followed up with in clinic.
B. It is best to make as little of an incision as possible to allow for the patient to heal quicker
*
A. True
C. Detecting the path of which the infection has traveled and opening up a tract from the entrance
point until the end point.
B. False
D. None of the above

4. * Which of the following best describes the reason why the patient developed his this particular
ulceration pattern?
3.
TrueA.orWork
False: The above patient may be treated with antibiotics alone, may be discharged from
boots
the hospital and followed up with in clinic.
A.
B. True
Insulated socks
* B.
C. False
Pes Cavus foot type
4. D. None of the above

Which of the following best describes the reason why the patient developed his this particular
ulceration pattern?
A. Work boots
5. * Which of the following diagnoses warrants surgical intervention?
A. Severe infection according to the IDSA
B. Tenosynovitis as way of spreading of the infection through the compartment
C. Spreading from plantar ulceration to dorsal compartment
D. All of the above

5.
Which of the following diagnoses warrants surgical intervention?
A. Severe infection according to the IDSA
* - Required
B. Tenosynovitis as way of spreading of the infection through the compartment
*
Submit
C. Spreading from plantar ulceration to dorsal compartment
D. All of the above
Submit

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PRESENT Podiatry Online CME & Conferences 8/26/18, 9)52 PM

PMHx: DM2, HTN

A. When the infection is potentially life-threatening, surgery is required

B. Surgery reduces pressure in the aﬀected compartments of the foot

C. Early surgical treatment may reduce the need for

D. All of the above are true

A. Surgically open all compartments of the foot for all infections

D. None of the above

A. Surgically open all compartments of the foot for all infections

D. None of the above

4. D. None of the above

5. * Which of the following diagnoses warrants surgical intervention?

A. Severe infection according to the IDSA

B. Tenosynovitis as way of spreading of the infection through the compartment

C. Spreading from plantar ulceration to dorsal compartment

D. All of the above

A. Severe infection according to the IDSA

D. All of the above

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