“La neuroartropatía de charcot en el pie diabético”

Abstract

Male patient of 58 years of age, married, resident in Pastocalle, with a history of Diabetes Mellitus type 2 diagnosed 15 years ago in insulin treatment with familiar family history: paternal grandfather with type 2 diabetes mellitus.

Patient comes due to difficulty walking 3 months of evolution that is accompanied by edema, heat, flushing and deformation, at the level of the inner border of the left foot is observed ulceration of 3 centimeters in diameter with irregular edges, so go to the center of health of Alaquez where they do not perform any procedure, for which he performs cures of his ulcer with hot water and medicinal herbs, as there is no improvement go to this house of health and decides to enter vascular surgery

At physical examination patient conscious, oriented, with stable vital signs, symmetrical thorax with preserved expandability; heart rhythmic heart sounds, lungs conserved vesicular murmur, abdomen soft, depressible, not painful to superficial and deep palpation, RHA present. Pulse pedions present. Decreased sensitivity and absent tendon reflexes.

X-ray of the left foot is made in which slight arterial calcifications are observed, with multiple osteolytic lesions in the tarsal area and proximal parts of the first and second metatarsals. An echo Doppler is requested, which shows a clear decrease in the speeds in anterior tibial arteries and later. In laboratory tests shows leukocytosis, but neutrophilia plus thrombocytosis with elevated CRP, in blood chemistry: fasting glucose: 235 mg / dl, cholesterol: 256 mg / dl and triglycerides: 180 mg / dl.

The first therapeutic behaviors used in this case were: empirical antibiotic therapy, a medication for primary hypercholesterolemia, general care, glycemia control, wound culture and cures twice a day of the ulcer plus immobilization of the left foot.