electronic-Perak Medical Journal. August 2022; Volume 2, Supplement 1 Journal homepage: http://gids.mohe.gov.my/index.php/pmj
21 CONFERENCE PROCEEDINGS
This abstract was presented in the 12th Annual Malaysian Rehabilitation Medicine Conference 3 September- 3 October 2021
CAN A KIND DIET TURN UNKIND? A RARE PRESENTATION OF NEUROPATHIC ULCER
Nurul Firdausi Binti Hasnol Basri1,3, Raiha Hasni Binti Mohd Hanaffi2,3, Chung Tze Yang3
1Jabatan Perubatan Rehabilitasi, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Kementerian Kesihatan MALAYSIA
2 Hospital Rehabilitasi Cheras, Kuala Lumpur, Kementerian Kesihatan MALAYSIA
3Rehabilitation Medicine Department, University Malaya Medical Centre
ABSTRACT
Keywords
foot ulcer, multidisciplinary, nutrition, rehabilitation, vitamin B12
Correspondence to:
Nurul Firdausi Binti Hasnol Basri [email protected]
INTRODUCTION
Peripheral Neuropathy is a disabling foot condition that can result in painless ulcer formation. The commonest cause of neuropathic ulcer is uncontrolled diabetes mellitus. Other causes include systemic infection, metabolic, toxins and nutrition malabsorption following bariatric surgery.
OBJECTIVES
1. Neuropathic ulcer as a complication of incomplete nutritional intake
2. Serial Total Contact Cast (TCC) as a gold standard management for neuropathic ulcer
3. Routine monitoring of full blood count and foot assessment should be done in primary healthcare setting in those opting to practice vegan diet
METHODOLOGY
We present a case report of a gentleman who developed chronic distal asymmetrical peripheral neuropathy with recurring ulcer on his right foot to our multidisciplinary footcare clinic – a team of rehabilitation physician, endocrinologist, orthopaedic surgeon and footcare nurses. He was diagnosed to be normoglycaemia and has no relevant past medical and surgical history.
RESULTS
After a thorough assessment, he was found to have an incomplete nutritional intake following a strict vegan diet for more than 15 years. His blood assay revealed a microcytic hypochromic anaemia with low B12 level. A gradual improvement and healing in the neuropathic ulcer were observed over a period of three months after undergoing a series of TCC and a comprehensive footcare education and multidisciplinary management.
CONCLUSION
This is a unique case of nutritional vitamin B12 deficiency symptomatic state with distal asymmetrical peripheral neuropathy with neuropathic pain and insensate foot which eventually led to development of neuropathic ulcer. It is a preventable condition considering Malaysia is no longer in food crisis post- independence when access to adequate nutrition is considered a scarcity. However, in individuals who opted for a strict vegan diet should seek medical consultation so that they can be supplemented accordingly. We suggest routine screening of full blood count and foot assessment in this population.