Question :

Complicated Post op. of plantar fasciitis with infection in a diabetic middle aged woman

Dear Ask The Doctor:
I recently had suegery to repair plantar favitis and remove bone spurs. I did get an infection at the incision site, which was treated with antibiotics. Now it is 10 weeks post op and the incision is still draining. The pain has reached my knee and seems to be creaping up my thigh. My foot is still swollen, as well as my ankle and lower leg. The doctof that did the surgery is treating me with another round of antiobiotics and well see me in two weeks. I don't know who to talk to, who to see, or what to do. I have a feeling that I have an infection in my bones. But, I'm not sure that is even possible. Who do I see? I just need to know what to do.

Answer :

Dear Patient: 
You have several risk factors to have developed the complication that you described in your question, meaning: diabetes, high blood pressure, obesity, gout. The management of your particular case is very difficult because all the comorbidities that you already have. Diabetes can affect every part of the body, including the skin. As many as 33 percent of people with diabetes will have a skin disorder caused or affected by diabetes at some time in their lives. In fact, such problems are sometimes the first sign that a person has diabetes. Some of these problems are skin conditions anyone can have, but people with diabetes get more easily. These include bacterial infections, fungal infections, and itching. Other skin problems happen mostly or only to people with diabetes. These include diabetic dermopathy, necrobiosis lipoidica diabeticorum, diabetic blisters, and eruptive xanthomatosis. But even today, people with diabetes have more bacterial infections than other people do. Doctors believe people with diabetes can reduce their chances of these infections by practicing good skin care. Inflamed tissues are usually hot, swollen, red, and painful. Several different organisms can cause infections, the most commong being Staphylococcus bacteria, also called staph. I strongly recommend a multi disciplinary management in your case: endocrinologist, infectologist and surgeon.

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