Patient Encounter 2 Part 1 Diabetic Foot Infection

A 47-year-old man with a long-standing history of type 1 diabetes presents to the primary care clinic with complaints of a nonhealing sore on his left foot. He has also noticed more pain and swelling than usual in his left lower extremity. While examining his foot, you see a mildly purulent lesion with induration 4 cm (1.6 in.) in diameter, and the presence of lymphangitic streaking. His foot is erythematous, warm, and tender to touch, and slightly malodorous, despite good foot hygiene. The patient indicates that the sore has been present for about 3 months, and he first noticed it after a day at the beach, where he spent most of the day barefoot. The patient's vital signs are within normal limits with the exception of a blood pressure of 135/88 mm Hg. He is afebrile.

What signs and symptoms present in this patient are indicative of a diabetic foot infection?

Based on presentation, classify this patient's diabetic foot infection using the PEDIS grading scale.

What additional information do you need before developing a therapeutic plan for this patient?

The most feared complication of infected diabetic foot ulcers is lower extremity amputation. More than 60% of all nontraumatic lower extremity amputations performed each year in Western nations are linked to diabetic foot infection; nearly

71,000 were performed in the United States in 2004.38

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