Resistant to treat diabetic foot with osteomyelitis and fingers amputation in type 1 diabetic patient with rheumatoid arthritis: a complicated primary care case report


Medical sciences  (2019) 1–9


Jūratė Pečeliūnienė1, Rita Šulcaitė2 , Eglė Kabašinskaitė3, Rūta Vosyliūtė3

1Vilnius University Faculty of Medicine, Clinic of Internal Diseases, Family Medicine and Oncology

2Lithuanian University of Health Sciences, the Institute of Endocrinology, Kaunas, Lithuania

3Vilnius University, Faculty of Medicine




Background: Description of a primary care clinical case of a resistant to treat diabetic foot with rheumatoid arthritis and developed osteomyelitis leading to fingers amputations, who on admission to endocrinologist presents ulcerations on left foot, of three months of evolution. Until the patient’s admission to the endocrinologist she has suffered repeated hospital admissions due to uncontrolled diabetes and feet ulcers, repeatedly changed orthopedic shoes, however, not completely fitting, which the patient finally refused to wear at all.

Aim, materials: The objective of this work is to demonstrate the importance of timely performing diagnosis of the lesion of diabetic foot, taking into account all risk factors that are present, and also the need to keep on diabetic foot management protocols, starting at the primary care institution level.

Methods, results: The information was evaluated with patient cooperation, after informed patient’s consent signed, also by analyzing documents of medical history; literature search analysis of the newest guidelines and data, including American Diabetes Association, European Association for the Study of Diabetes, International Diabetes Federation and International Working Group on the diabetic foot, as well as the latest scientific diabetic foot articles, was performed.

Conclusion: In order to prevent diabetic foot lesions in complicated, uncontrolled, long lasting diabetes with chronic comorbidities, related to foot and joint pathologies, such as rheumatoid arthritis, certain protocols must be strictly followed by multidisciplinary team in close cooperation with primary care institution. An individual approach towards patients’ diabetic foot prevention and treatment plan should be applied in such cases to avoid diabetic foot ulcers’ complications and lower extremities amputations.

Key words: Diabetes mellitus, resistant to treat ulcers, osteomyelitis, amputation, primary care.