Treatment of neuropathic plantar ulcer in diabetic foot syndrome (clinical observation)

Introduction. Diabetes mellitus is a serious disease, firmly occupying the first place in disability and the third place in mortality in the world. One of the most dangerous complications of diabetes mellitus is diabetic foot syndrome, since this complication is the main "culprit" of amputation and disability of patients. The absence of pain sensitivity in patients with neuropathy complicates the treatment of plantar ulcers. Widely and successfully applied modern methods of treatment will not lead to the healing of the ulcer defect without unloading the foot. To prevent the formation and recurrence of plantar neuropathic ulcers, it is optimal to make individual orthopedic shoes.Clinical case. Patient R., 58 years old, complained of an increase in temperature to 38.40 C, redness and swelling of the left foot and lower leg, the presence of calluses with ulceration on 1 finger of the left foot, redness, swelling and ulcerative defect of 2 fingers of the left foot. Without receiving medical care in the polyclinic and in the diabetic foot center, the patient turned to us. At the first examination, the nail phalanx was removed with a pitted articular surface of 2 fingers of the left foot. Further treatment for three weeks led to the healing of ulcerative defects. However, after stopping wearing the orthosis and prolonged load on the foot, the patient suffered a hemorrhage in the callus of the 1st finger with subsequent infection. The refusal to wear the orthosis delayed the treatment process for three months. Only after the patient began to use unloading shoes, the ulcer was healed. Conclusion. This clinical observation demonstrates problems in the treatment of diabetic foot ulcers. The wrong tactics of the outpatient doctors almost led to the loss of a part of the patient's limb. The inadequate attitude of the patient to his disease has complicated and prolonged the treatment of the ulcer defect. Only joint efforts will reduce disability and mortality in such a complication as diabetic foot.