Case 101: Infected Neuropathic Leg Saved from Amputation

At age 46, this woman with insulin-dependent diabetes, which had been poorly controlled for 22 years, visited her podiatrist for an infected callus under her right 5th metatarsal head. He debrided it and started her on oral antibiotics and Epsom foot soaks. As the ulcer and its infection progressed, she was referred to a vascular surgeon who hospitalized her for intravenous antibiotics (gentamicin and tetracycline) and bedrest. Her ulcer continued to enlarge. Her fever persisted (101°F) and her leukocytosis increased (17.7 to 20.2). A boot consultation was requested on the 4th hospital day.

January 18th, 1989: Necrotic fat beneath the 3rd to 5th toes, slight purpling of the 3rd toe and blackening of the 5th toe are noted.

January 18th, 1989: The dorsum of the foot and of all the toes but the first were reddened.

Her dorsalis pedis and posterior tibial pulses were easily palpable. Light touch and position senses were absent and two-point discrimination was over 25 cm. Local antibiotic therapy was begun with injections of gentamicin into the foot and Mini-Boot therapy with the foot immersed in Sea Soaks and gentamicin. She improved. Unfortunately, the local antibiotic injections were discontinued for a week while the boot doctor was on vacation in Morocco. The foot deteriorated and her surgeons urged leg amputation. She refused. On February 28th, the Local injections were restarted. She did well

May 26th, 1989: Her left 5th toe atrophied while the other toes fully recovered.

May 26th, 1989: She continued to grow callus, which was periodically debrided, under her 5th metatarsal head.

Comments: This case was reported in Angiology 48: s46-s48, 1997. She is another good example of the power of boot therapy in treating necrotizing cellulitis in the diabetic..