The Rational Clinical Examination
David L. Simel, Drummond Rennie
Diabetes, Foot Ulcer
Sonia Butalia, Valerie A. Palda, Robert J. Sargeant, Allan S. Detsky, Ophyr Mourad
Sections:
Clinical Scenarios, Why Is This Diagnosis Important?, Clinical Evaluation of the Lower Extremity in Patients With Diabetes, Methods, Results, Scenario Resolutions, Clinical Bottom Line, References
Topics Discussed:
diabetes mellitus, diabetes mellitus, type 1, diabetes mellitus, type 2, diabetic foot ulcer, erythrocyte sedimentation rate, foot ulcer, leg ulcer, osteomyelitis, osteomyelitis of ankle and foot, osteomyelitis, bacterial
Excerpt:
"A 52-year-old woman is referred from the emergency
department with a diabetic foot ulcer. She has type 1 diabetes mellitus
that was first diagnosed at age 12 years. Her condition is complicated
by nephropathy, retinopathy, and peripheral vascular disease. She
has recently noticed erythema, swelling, and pain over the left
foot. On physical examination, she has a pulse of 90/min,
blood pressure of 136/84 mm Hg, and temperature of 36.1°C.
Pedal pulses are diminished. There is a 2.2 x 1.5-cm
ulcer in the toe webbing that probes to underlying bone. Investigations
reveal a white blood cell count of 9500/µL and an erythrocyte
sedimentation rate (ESR) of 75 mm/h. Wound swab Gram stain
reveals gram-positive cocci and gram-negative
bacilli. Radiographs of the foot identify soft tissue swelling and
cortical erosion in the area of the ulcer. Should magnetic resonance
imaging (MRI) of the foot be ordered?..."
Log in to read the full chapter:
Get full access to JAMAevidence two ways:
Subscribe to JAMAevidence
JAMAevidence is a subscription-
based website dedicated to the learning, teaching, and practicing of evidence-based medicine.
Pay Per View
Timed access to all of JAMAevidence
24 hours for $29.95
48 hours for $49.95