A touch of athlete’s A touch of athlete’s foot?foot?

An uncommon diabetic An uncommon diabetic presentationpresentation

A brief historyA brief history

Mr GE Mr GE • 51 year old male51 year old male

PC: PC: Painful swollen left footPainful swollen left foot

HPC:HPC:• 2/12 prior to admission, went 2/12 prior to admission, went

walking in Amsterdam on walking in Amsterdam on cobbles causing bruised feet.cobbles causing bruised feet.

• 10/7 prior to admission, 10/7 prior to admission, noticed that foot was noticed that foot was becoming slightly painful and becoming slightly painful and erythematous.erythematous.

• 1/7 prior to admission, presented to Weston S-Mare 1/7 prior to admission, presented to Weston S-Mare A+EA+E– Foot swollen and tender, small area of erythemaFoot swollen and tender, small area of erythema– BM 22BM 22– Admission debated, but patient eventually given oral Pen V Admission debated, but patient eventually given oral Pen V

and Fluclox and told to attend GP on Monday after weekend.and Fluclox and told to attend GP on Monday after weekend.

• Following day came down to Torquay!Following day came down to Torquay!• Foot increasingly tender and swollen -> A+EFoot increasingly tender and swollen -> A+E

• On direct questioning:On direct questioning:– No polydypsiaNo polydypsia– Normally polyuric but on frusemide.Normally polyuric but on frusemide.– Had noticed increased weight loss over previous two years Had noticed increased weight loss over previous two years

but had been dieting.but had been dieting.– Denied any awareness of loss of sensation in feet or Denied any awareness of loss of sensation in feet or

neuropathic Sx.neuropathic Sx.

PMH:PMH:• HypertensionHypertension

DH:DH:• Atenolol 50mg ODAtenolol 50mg OD• Enalapril 40mg ODEnalapril 40mg OD• Frusemide 40mg ODFrusemide 40mg OD• NKDANKDA

FH/SH:FH/SH:• Non smokerNon smoker• ETOH – up to 20units/weekETOH – up to 20units/week

O/EO/E• Pyrexial Temp 38°CPyrexial Temp 38°C• ObeseObese• Chest: NADChest: NAD• Abdo: NADAbdo: NAD• Legs: Swollen discoloured left footLegs: Swollen discoloured left foot

Area of cellulitis over left shinArea of cellulitis over left shin• Fundoscopy showed small micro aneurysms Fundoscopy showed small micro aneurysms

near point of fixation.near point of fixation.

Bloods:Bloods:• WCC 15WCC 15• HB 17.0HB 17.0• PLT 173PLT 173

• Na 131Na 131• K 4.8K 4.8• Ur 7.1Ur 7.1• Cr 105Cr 105

• Glu 22.5Glu 22.5• Ketones TraceKetones Trace

Microbiology:•Group B Streptococci

•Light growth of anaerobes

Management:Management:• IV Antibiotics:IV Antibiotics:

– Benzylpenicillin 2.4g QDSBenzylpenicillin 2.4g QDS– Flucloxacillin 1g QDSFlucloxacillin 1g QDS– Metronidazole 500mg TDSMetronidazole 500mg TDS

• Initially on insulin sliding scale but converted to Initially on insulin sliding scale but converted to QDS regime on wardQDS regime on ward

• Diabetes Specialist Nurse reviewDiabetes Specialist Nurse review• Dietician reviewDietician review• Retinal screeningRetinal screening