Endocrine DOI 10.1007/s12020-013-0156-z
ENDOCRINE IMAGING
Diabetic foot in a patient with polydactyly Yuxin Huang • Haidong Wang
Received: 12 December 2013 / Accepted: 20 December 2013 Ó Springer Science+Business Media New York 2014
A 52-year-old man with six toes and a history of diabetes mellitus for 30 months suffered from poor glycemic control, and the toes gap appeared to be rotten within a month. Physical examination revealed a normal five-toe right foot and a six-toe left foot with relatively narrow toe clearance. The intermediate four toes on the left foot showed fungal infection, skin ulceration and effusion (Fig. 1). Laboratory tests revealed the glycosylated hemoglobin of 8.2 %, the glycated albumin of 22 %, the hypersensitive C-reaction protein level of 0.3 mg/L and the white blood cell count of 6,000 per cubic millimeter. The foot radiography showed polydactyly in the left foot without one bone or joint destruction (Fig. 2). These findings supported the diagnosis of diabetic foot with fungal infection. After the patient was treated with intensive insulin therapy, foot care and antifungal medicines (fluconazole per os and 1 % neomycin solution for external application) for 2 weeks, rotten toes gradually recovered. As is well published, there are several risk factors for diabetic foot. Some factors are local (such as peripheral neuropathy, foot trauma, decreased tissue perfusion, illfitting shoes and walking barefoot) and others are systemic (such as metabolic disturbances and malnutrition) [1]. In
Fig. 1 A six-toe left foot with skin ulceration
addition, lipoprotein (a) and homocysteine as genetic risk factors can favor ulcerations [2]. By this case, we find that polydactyly may represent an additional risk factor for diabetic foot.
Y. Huang (&) H. Wang Department of Endocrinology, Shanghai Huadong Hospital Affiliated to Fudan University, Shanghai, China e-mail: [email protected]
123
Endocrine
Fig. 2 The foot radiography of the six-toe left foot
Conflict of interest We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work.
References 1. J. Apelqvist, Endocrine 41, 384–397 (2012)
123
2. C. Gazzaruso, A. Coppola, T. Montalcini, E. Baffero, A. Garzaniti, G. Pelissero, S. Collaviti, A. Grugnetti, P. Gallotti, A. Pujia, S.B. Solerte, A. Giustina, Endocrine 41, 89–95 (2012)
ENDOCRINE IMAGING
Diabetic foot in a patient with polydactyly Yuxin Huang • Haidong Wang
Received: 12 December 2013 / Accepted: 20 December 2013 Ó Springer Science+Business Media New York 2014
A 52-year-old man with six toes and a history of diabetes mellitus for 30 months suffered from poor glycemic control, and the toes gap appeared to be rotten within a month. Physical examination revealed a normal five-toe right foot and a six-toe left foot with relatively narrow toe clearance. The intermediate four toes on the left foot showed fungal infection, skin ulceration and effusion (Fig. 1). Laboratory tests revealed the glycosylated hemoglobin of 8.2 %, the glycated albumin of 22 %, the hypersensitive C-reaction protein level of 0.3 mg/L and the white blood cell count of 6,000 per cubic millimeter. The foot radiography showed polydactyly in the left foot without one bone or joint destruction (Fig. 2). These findings supported the diagnosis of diabetic foot with fungal infection. After the patient was treated with intensive insulin therapy, foot care and antifungal medicines (fluconazole per os and 1 % neomycin solution for external application) for 2 weeks, rotten toes gradually recovered. As is well published, there are several risk factors for diabetic foot. Some factors are local (such as peripheral neuropathy, foot trauma, decreased tissue perfusion, illfitting shoes and walking barefoot) and others are systemic (such as metabolic disturbances and malnutrition) [1]. In
Fig. 1 A six-toe left foot with skin ulceration
addition, lipoprotein (a) and homocysteine as genetic risk factors can favor ulcerations [2]. By this case, we find that polydactyly may represent an additional risk factor for diabetic foot.
Y. Huang (&) H. Wang Department of Endocrinology, Shanghai Huadong Hospital Affiliated to Fudan University, Shanghai, China e-mail: [email protected]
123
Endocrine
Fig. 2 The foot radiography of the six-toe left foot
Conflict of interest We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work.
References 1. J. Apelqvist, Endocrine 41, 384–397 (2012)
123
2. C. Gazzaruso, A. Coppola, T. Montalcini, E. Baffero, A. Garzaniti, G. Pelissero, S. Collaviti, A. Grugnetti, P. Gallotti, A. Pujia, S.B. Solerte, A. Giustina, Endocrine 41, 89–95 (2012)
