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Well the query is informative here are my opinions and ideas,
1)History about smoking
, alcohol ( if any ),Atherosclerotic illness and previous treatments for the ulcer would be more helpful.
2)The primary goal of mine would be for a conservative management and preserve the toes if possible .
3)No , the diabetic control is not much convincing as the HbA1c
is boredrly higher.Reading ranging from 4 to 7 would be favorable.Control achieved by diet modification is a long standing type as the treatment of the toe ulcers needs that.
4)I would like the patient to stay on low carb diet and maintain good cleanliness of the ulcers by frequent sterile dressings with a better antibacterial cream.
5)First i would like to ask for a Culture sensitivity test of the discharge from both the ulcers separately , the success of the medical management if planned depends on these reports. If we dealing with resistant variety debridement may have to be considered.If the wound is sterile then lowering the sugar levels by diet and good sterile dressing with antibacterial would be sufficing intervention.
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