Diabetic Foot Files

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 with infectious disease involvement for ESBL or carbapenem-resistant strains. The episode also reviews prevention strategies, the role of vascular assessment, and current research directions including anti-biofilm approaches and adjunctive therapies.

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 by metabolic dysfunction. The episode also outlines how modern clinicians would evaluate and treat such wounds—vascular studies, glucose control, compression, debridement, and multidisciplinary care—and emphasizes that correct diagnosis, not status or money, is what heals chronic wounds.

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: TripleClear HF can be used preventively or as primary therapy to reduce fungal burden, improve compliance through rapid visible effects, and may play a role in long‑term diabetic foot hygiene and limb preservation alongside blood sugar control and daily foot checks.

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 antibiotics, aggressive debridement, and vascular assessment.

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 tips (deep tissue culture, susceptibility testing), prevention strategies (sterile irrigation, avoid unnecessary broad-spectrum antibiotics, moisture control, early culturing) and why this quiet organism is a marker of chronicity and limb-threatening risk.