Nguyen Khoi was admitted to Tam Anh General Hospital in Ho Chi Minh City with severe foot pain, persistent high fever for several days, and a 2 kg weight loss. Doctors diagnosed a severe infection in his left foot, extremely high blood sugar at 27,7 mmol/l (normal range: 4-7,8 mmol/l), multiple deep abscesses, and widespread necrosis in his toes.

Specialist Doctor I Pham Thi Thu Ha from the Endocrinology and Diabetes Department stated that three of Nguyen Khoi's toes were suffering from osteomyelitis, a sign that the infection had penetrated and caused bone inflammation. He received treatment with broad-spectrum antibiotics, aggressive blood sugar control using insulin, and fluid replacement; however, the infection continued to progress.

Nguyen Khoi receiving treatment in the Endocrinology and Diabetes Department. *Photo: Tam Anh General Hospital*.

According to Doctor Ha, the widespread damage, osteomyelitis, and deep abscesses made limb salvage options almost impossible. Doctors were forced to amputate nearly three necrotic toes to prevent the infection from spreading and causing sepsis. Additionally, the patient was treated with a negative pressure wound therapy (VAC) device to drain pus, promote rapid wound healing, and prevent further infection spread. However, his foot's dorsum remained swollen and red, and the risk of needing a full foot amputation has not been ruled out.

Doctor Ha explained that for diabetic patients, the foot is a typical "biological weak point" due to the convergence of three mechanisms: peripheral neuropathy, which reduces protective sensation; vascular disease, which causes reduced tissue perfusion; and immune dysfunction, leading to poor infection control.

When initial injuries occur, especially in non-sterile environments like applying leaves or soaking in herbal water, bacteria can easily enter and rapidly proliferate, potentially causing infection and necrosis. Doctor Ha advises diabetic patients to carefully manage stable blood sugar levels. Upon discovering an injury, patients should not self-treat by applying herbal remedies or soaking their feet; instead, they must follow a doctor's treatment plan to prevent complications.

Bach Duong

*Patient's name has been changed