A case presentation of leg ulcers

1. Leg Ulcer
A Clinical Case Presentation
Rakesh A
4th Year MBBS
Shridevi Institute of Medical Sciences
& Research Hospital
Tumakuru

2. Patient Particulars
• Name – Mr ABC
• Age – 53 years
• Sex – Male
• Education – 7th Class
• Occupation – Carpenter
• Address – BG palya, Tumakuru
• Socioeconomic status – Class 4 according modified BG Prasad
classification
• DOE – 1st October 2021
• DOE - 1st October 2021

3. Chief Complaints
Wound over left foot since three months

4. History of presenting illness
• Patient is a known case of diabetes Mellitus from past 20 years and has
a history of smoking from last 30years.Patient was apparently normal
three months back, later he met with an accident which led to a
wound over dorsal aspect of left foot near 4th and 5th toe. Initially
wound size was approximately 1cm and gradually progressed to involve
the whole of the 4th and 5th toe.
• Patient also complaints of discharge from the wound since 2 ½ months
initially scanty watery discharge. Later, it was foul smelling purulent
discharge from last 3 weeks.
• Wound was not associated with pain.
• No history of claudication in the lower limbs.
• No history of altered sensations in the lower limbs.

5. Past medical history
• Known case of diabetes from 20 years.
• Patient was on oral hypoglycaemic drugs for first 14 years.
Blood sugars levels were uncontrolled since last 6years so
he is on insulin therapy
• Not a known case of Hypertension/TB/Asthma/epilepsy.

6. Past surgical history
• Patient had a similar complaint 5 years back for which he
underwent amputation of big toe of left foot at CMC
Vellore.
• 3 years back, he underwent amputation of 2nd and 3rd toe
of left foot for similar complaint at CMC Vellore.

7. Family history
• History of diabetes mellitus in the family.

8. Personal history
• Diet – Mixed
• Appetite – Normal
• Sleep – adequate
• Bowel and bladder – Normal
• Abusive habits – Smoking and alcohol consumption from last
30 years

9. Summary
• A 53 year old patient who is a known case of
diabetes since 20 years on regular medication
presents with the wound over the dorsal aspect of
lateral side of left foot after sustaining an injury 3
months back which was initially associated with
scanty serous discharge which gradually
progressed to foul smelling discharge not
associated with pain.

10. General physical examination
• A 53 year old patient who is moderately built, moderately nourished,
conscious, cooperative and well oriented to time, place and person.
• Height – 175 cm
• Weight – 68 kg
• BMI – 22.2 kg/𝑚2
• No pallor, icterus, clubbing, cyanosis, generalised lymphadenopathy and
edema

11. Vitals
• Pulse – 70 bpm, regular rhythm, normal volume,
all peripheral pulses were felt.
• Blood pressure – 112/78 mmhg, measured in right upper
limb on sitting position
• Respiratory rate – 18/min
• Temperature – 98.7 °F

12. Local examination
Inspection
• A single ulcer irregular in shape present on
the lateral side of dorsal aspect of left foot
which measures approximately 3×6 cm,
sloping edges with inflammation and edema.
Floor is covered with pale tissue with slough
and granulation tissue in the centre of ulcer.
• There is serous discharge, foul smelling.
• Surrounding area is hypopigmented.

13. • There was a another ulcer on the sole of the
left hindfoot which was round in shape
measuring 2×2cm, punched out edges. Floor
is covered with granulation tissue, surrounding
area is hypopigmented.
• Rest of the left limb is normal
• Joint movements are normal

14. Palpation
• No local rise of temperature and tenderness
• A ulcer present on the left foot over dorsal aspect,
measuring 3.5×7cm, irregular in shape. There is sloping
edge with well defined margin. No induration, depth
ranging from 0.5 to 1cm. Ulcer is immobile and do not bleed
on touch, base is muscle and tendons. Associated with loss
of sensation over ulcer and surrounding 3-4cm area.

15. • Ulcer is present over the sole of left foot, measuring
2×2cms, round in shape. There is punched out
edges with slight induration and distinct margin,
depth measuring up to 1cm. Ulcer is immobile, do
not bleed with touch, base is muscle. Associated
with loss of sensation over ulcer and surrounding 2-
3cm area.
• Not associated with loss of sensation over other
parts of left lower limb

16. EXAMINATION OF LYMPH NODES
• no enlarged lymph nodes in the inguinal region.
EXAMINATION OF VASCULAR DISEASE
• no signs suggestive of vascular disease
EXAMINATION OF NERVE DISEASE
• no signs suggestive of nerve disease

17. SYSTEMIC EXAMINATION
CARDIOVASCULAR SYSTEM
• S1 and S2 heard, No murmurs
RESPIRATORY SYSTEM
• Normal Vesicular Sounds are heard, No added sounds
PER ABDOMEN
• Soft, non tender and no organomegaly
CENTRAL NERVOUS SYSTEM
• No focal neurological deficit present

18. Provisional diagnosis
A 53 year old patient who is a known case of
diabetes with chronic non healing ulcer on the
dorsal aspect of lateral side of left foot and
tropic ulcer on the sole of left hindfoot.

19. Thank you..