Diabetic Foot Files

This episode explains bone scans as functional, nuclear medicine tests that reveal bone metabolism—blood flow, inflammation, infection, and repair—often before structural imaging shows changes.

Learn the three phases (flow, blood pool, delayed), how osteomyelitis typically lights up all phases, pitfalls like Charcot foot and ischemia, and advanced options (SPECT‑CT, labeled white blood cell scans, PET) that improve diagnosis and gu...

In this episode we break down skin substitutes for diabetic foot ulcers: how they work biologically, why they are not interchangeable, and common errors clinicians make.

We review major categories and examples (bioengineered cellular grafts like Apligraf and Dermagraft; human dermal matrices like AlloDerm and GraftJacket; placental/amniotic products like EpiFix and Grafix; xenografts such as Integra; and synthetic matrices like OAS...

This episode explains that diabetic foot ulcers are driven by "biological paralysis" rather than just skin loss, describing the four phases of wound healing and why wounds get stuck in chronic inflammation.

Dr. G reviews key failure mechanisms—protease imbalance, fibroblast dysfunction, persistent M1 macrophages, angiogenic failure, and stem cell impairment—and how skin substitutes can replace extracellular matrix, rebalance cytoki...

In this episode of Diabetic Fudge Files' Royal Wounds series, Dr. G examines the final illness of King Charles II to show how aggressive, theory-driven treatments like bloodletting, purging, and blistering can cause iatrogenic harm.

Using the king's case as a warning, the episode draws direct parallels to diabetic wound care today: prioritize physiology and perfusion, diagnose before intervening, practice restraint, and focus on ta...

In this episode of Diabetic Foot Files — Royal Wound Series, we examine Alexei Romanov's hemophilia B, tracing how an X‑linked clotting deficiency shaped his life and destabilized a dynasty.

We explain the clotting cascade failure that leaves fragile, delayed fibrin clots, why patients suffer deep joint and muscle bleeds, and what wounds hemophilia predisposes to.

Finally, we cover modern diagnosis and treatment — APTT, factor assa...

This episode uses Queen Victoria as a clinical mirror to explain how immobility leads to venous hypertension, edema, skin breakdown, and chronic venous leg ulcers. It covers the classic triad—venous hypertension, valve failure or obstruction, and calf muscle pump dysfunction—and why ulcers often appear in the gaiter region with persistent inflammation and fragile skin.

The episode also outlines modern management: accurate vascular ...

This episode examines King George III's documented episodes of severe mental illness and modern re-evaluation (bipolar disorder vs porphyria), then connects the biology of stress—HPA axis, cortisol, and catecholamines—to impaired diabetic foot ulcer healing.

It explains how depression, agitation, and self-neglect worsen outcomes and outlines a humane, multidisciplinary modern treatment plan that pairs wound care with psychiatric an...

Dr. G explores how unrelieved pressure — not just diabetes or infection — can destroy tissue, using Napoleon Bonaparte’s chronic foot pain, stiff military boots, and relentless marching as a historical case study. The episode explains how tight footwear, prolonged weight-bearing, cold, and vascular compromise lead to ischemia and pressure ulcers, and why pain, calluses, and blisters are important warning signs.

The clinical takeawa...

This episode of Diabetic Foot Files focuses on Klebsiella pneumoniae as an emerging and dangerous pathogen in diabetic foot ulcers, highlighting its capsule, biofilm formation, and rising antimicrobial resistance.

It covers clinical presentation, the importance of deep tissue cultures, diagnostic tips, and a three-pronged treatment approach: source control (debridement), mechanical offloading, and targeted antimicrobial therapy wit...

In this episode of Diabetic Foot Files Dr. G opens the mini-series "Royal Wounds" by asking whether King Henry VIII’s notorious, years-long lower-leg wounds were due to diabetes, venous disease, or a mixed cause. Using historical accounts of his obesity, post-jousting trauma, chronic swelling, foul drainage, and fluctuating pain, the episode argues that his wounds most closely match chronic venous or mixed-etiology ulcers worsened ...

Dr. G interviews Dr. Andronica Handie, DPM, MS about combining his background in nuclear medicine and biopharmaceutical sciences with podiatric innovation to tackle onychomycosis in diabetic patients. They discuss TripleClear HF, an all‑natural topical antifungal using nanotechnology to penetrate nail plates, trial results showing marked reductions in nail thickness, and safety advantages over systemic antifungals.

Takeaways: Tripl...

Dr. G breaks down Morganella morganii — a gram-negative, urease-producing opportunist that appears in late-stage diabetic foot ulcers when tissue is necrotic, hypoxic, and antibiotic-weakened.

The episode covers its origin, why it thrives in alkaline, chronic wounds, typical clinical signs, diagnostic pitfalls in polymicrobial cultures, intrinsic resistances (eg, ampicillin), treatment priorities like deep cultures, targeted antibi...

Episode decoding Stenotrophomonas maltophilia — a water-associated, multi-drug resistant bacterium that thrives in hospital plumbing and chronic diabetic foot ulcers. Learn how it forms biofilm, resists many antibiotics, and presents as a chronic non-healing wound that often requires targeted therapy (trimethoprim-sulfamethoxazole), aggressive debridement, and ecosystem-based care.

We cover reservoirs and transmission, diagnostic t...

Dr. G dives into the Proteus genus—Proteus mirabilis and Proteus vulgaris—explaining their history, swarming behavior, urease-driven alkalinization, virulence factors, and why diabetic foot ulcers provide the perfect environment for these pathogens.

The episode covers clinical clues (strong ammonia odor), diagnostic differences, biofilm-driven resistance, treatment priorities (sharp debridement, systemic antibiotics, pH control, an...

In this episode of Diabetic Foot Files we explore Serratia marcescens — a red-pigment producing, opportunistic gram-negative bacterium that can rapidly worsen diabetic foot ulcers. We cover its history, microbiology and virulence, clinical clues (including the telltale pink drainage on dressings), diagnostic tips, and culture-directed treatment strategies.

The episode also reviews wound care approaches to disrupt biofilm, antibioti...

Dr. D breaks down two standardized swab techniques—the Levine and the Essen rotary methods—and explains why proper wound cleansing and pressure-based sampling are critical to getting accurate cultures. Learn step-by-step instructions, common mistakes to avoid, and when to use each method for diabetic foot ulcers.

This episode highlights evidence comparing each technique to deep tissue biopsy, real clinical case examples, and practi...

In this episode of Diabetic Foot Files we walk through below‑knee amputation (BKA): why it’s performed, how surgeons select the level, and the step‑by‑step surgical technique including flap design, vascular and nerve management, and bone handling.

We discuss risks of delaying surgery, post‑op care and staged rehabilitation, pain and phantom limb strategies, and the key questions patients and families should ask when facing a BKA.

C...