Munawar Jamil, Asgher Ali, Muhammad Amin.
Osteomyelitis of the foot in Diabetic patients.
J Surg Pak Jan ;8(3):32-4.

Objective: To find out the proportion of osteomyelitis (grade 111) in patients of diabetic foot and their out come and how can we decrease the amputation rate in these patients .Design: A descriptive and observational study. PLACE AND DURATION OF STUDY Patients with diabetic foot, admitted in Surgical Unit 1, B. V.Hospital, Bahawalpur, from January 2000 to January 2003. SUBJECTS AND METHODS: Patients were assessed for prevalence and management of grade 111 diabetic foot especially with regard to incidence, age and sex group, clinical presentation and various surgical options. Necessary investigations including x-ray foot , ECG, serum urea and creatinine , pus culture and sensitivity were carried out. Diabetes was controlled on insulin on the basis of serum sugar and urine sugar chart. RESULTS: A total of 80 known diabetic patients were studied, out of these 58 were male and 22 female. In this study of 80 cases of diabetic foot, majority of patients (58.5%) were male in fifth and sixth decade of life. Male to female ratio was 2.8:1. Involvement of foot was usually confined to forefoot involving the big or little toe, with 66.6% osteomyelitis of distal phalanx. In majority of the cases (52.5%), patients presented with grade-111 diabetic foot with bone involvement and in 22.5% of the cases with localized gangrenous (grade-IV) diabetic foot. History of penetrating trauma was present in 35% of cases followed by peripheral neuropathy in 30% of cases & corn and callosities in 15% of cases. Patients with grade-111 diabetic foot were advised flouroquinolones and clindamycin regime was used in 50% of cases after c/s. In 25% of the cases fouroquinolone+MTZ were used with good response while in 6.25% of cases of septicemia, 31 generation cephalosporins were used. Toe and ray amputations were done in 35% and 16.25% of cases respectively. Below knee amputation was performed in 10%, above knee amputation in 2.5%, calcaneal resection in1.25%. Wound infection was the main complication in 25% of the cases. CONCLUSION: Once osteomyelitis is established, its` hard to treat and end result may be some kind of amputation. The basic principle of the management include early detection of diabetic foot, early control of infection, control of diabetes and wound care in the form of debridement . It is evident that early diagnosis demands a method of seeking the patients rather than waiting for the patients.

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