Case 1

A 42-year-old insulin-dependant diabetic man came to us when a callous on
his foot had turned into an ulcer that would not heal. Another podiatrist had
placed him on Levoquin but with no improvement. He was referred to our clinic
four months after the onset of the ulcer. Our vascular surgeons saw him and
demonstrated by arterial dopplers that he had good arterial blood flow to the
foot. Cultures were taken that indicated he had Pseudomonas aeruginosa, a
type of bacterial infection. The ulcer could be probed to the bone. X-rays did
not did not indicate osteomyelitis. The patient was placed on Imipenem on
June 22, 2001 and the third metatarsal head was resected on July 6, 2001.
By August 24, 2001, the ulcer was completely healed. The patient had
only one other episode of ulcer breakdown, which occurred one year
later and was successfully treated with medical management.


Case 2

A 33-year-old insulin-dependant diabetic man weighing 322 pounds with
Chronís disease came to us with an ulcer that had first been evaluated and
treated in Maine. The man had had several ulcers in the past year that had
not been resolved completely. He had an ulcer on the ball of his left foot for
one year. In May 2000 it had became red and swollen and had progressed up
his leg. The patient returned to the Buffalo area for further treatment. In our
initial evaluation of the ulcer we found that it could be probed to the bone.
We took cultures, proscribed IV antibiotics and arranged for a metatarsal re-
section. This was accomplished on May 25, 2000 and the pathology showed
osteomyelitis. By July 5, 2000, the ulcer had fully healed.