DAN PREECE RI

Case Report

Cc: painful red hot foot

HPI: 53 yo diabetic male who presents to the ED with red, painful swollen right foot. Denies trauma, puncture, wounds etc. States that the same thing happened two years ago, was placed in a CAM walker and the problem resolved itself after 2-3 months. Denies FCNV. Says he feels “fine” except for pain to the foot.

What do you want to know now? What would you do? What imaging do you want?

PMH: DMII, Tobacco, hyperlipidemia, iv drug use.

Meds: diclofenac, lisinopril, metformin, simvastatin, trazadone.

Social: homeless, drug abuse, works as carpenter.

Post - op

Wound was flushed and packed for 4 days.

Returned to OR, closed plantar wound that did not communicate with other incision, discovered dorsal pocket of purulence, drained and left drain connecting two dorsal wounds.

Pt began to complain of severe neck pain after laying in bed for days. What would you do?

MRI revealed abscess and osteomyelitis of C4-6, neuro surgery performed laminectomy.

Two weeks after initial I and D

Two weeks after initial I and D

Packed and flushed for 4 more days, closed remaining wounds, started 6 weeks of IV antibiotics. Healed completely.