A 55-year-old diabetic man undergoes debridement for a neuropathic plantar ulcer over the first metatarsal head. The most important initial investigation before deciding on vascular reconstruction is:
- A Plain radiograph to assess for osteomyelitis
- B Ankle-Brachial Pressure Index (ABPI) and Toe-Brachial Pressure Index (TBPI) or transcutaneous oxygen tension (TcPO2) ✓
- C MRI of the foot to delineate soft-tissue extent
- D Wound swab for culture and sensitivity
Correct answer: B. Ankle-Brachial Pressure Index (ABPI) and Toe-Brachial Pressure Index (TBPI) or transcutaneous oxygen tension (TcPO2)
Explanation
In the diabetic foot, identifying the ischaemic component determines whether healing is possible without revascularisation. ABPI (unreliable in calcified vessels of diabetics, so TBPI or TcPO2 is preferred — TcPO2 > 40 mmHg predicts healing) must precede definitive surgical planning. MRI is valuable for osteomyelitis delineation but does not guide vascular decision. Culture is obtained but does not affect the immediate surgical strategy regarding vascularity.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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