74 years old Gentleman, type 2 DM , hypertension, high BMI, presented to accident and emergency with 48 hours history of sudden onset of pain, redness and swelling of the left foot. Temp 37, pulse 80 and BP 125/70
His blood result shows : Hb 107 , WCC 7, CRP 15
The A&E doctors asked for your advise as they found it very difficult to palpate the foot pulses.
what is the differential diagnosis for this patient ? investigation to help with reaching diagnosis?
what is the next step of management?
Dx
Acute charcot
Septic arthritis
Celullitis
Osteomylitis
Insect bite
Advices is
Full labs
Arterial duplex ABI
Foot x ray
MRI foot
Hydration
Off loading meaures
Antibiotic analgesia
Close follow up
Differential diagnosis for this case may be:
1.Osteomyeitis
2.Deep seated infection
3.Acute Charcot neuroarthropathy
4.Cellulitis
5.Superficial thrombophlebitis
6.Gouty arthritis
Recommended investigations:
Lab:
1.RBG
2.HA1c
3.Lipid profile
4.Serum uric acid
Radiology:
1.Foot X ray
2.Dupplex US
3.MRI foot ( to detect early stages of Charcot)
Our next step:
1.Proper control of blood glucose level
2.Good hydration
3.Adequate analgesic
4.Antibiotic
5.Bisphsophnate ( if my provisional diagnosis is charcot)
6.Rest, limb elevation and weight bearing avoidance.
7.Close follow up
Dx
Acute charcot
Septic arthritis
Celullitis
Osteomylitis
Insect bite
Advices is
Full labs
Arterial duplex ABI
Foot x ray
MRI foot
Hydration
Off loading meaures
Antibiotic analgesia
Close follow up
Dd
Acute charcot
Cellulitis
Abcess
Skin rash
Acute ischemia
Cli e ischemia rubra
Investigation
Labs
Ecg echo
Plain x ray
MRI
Duplex arterial+venous/ abpi/tp
Next step
Tlc 7
Swelling localized around mid foot joints I would go e MRI after exclusion of other causes by duplex
Then fixation. And bisphosphonate