Case 106: Sensation Improved and Paronychia Cured

Our local chapter of the American Diabetes Association referred this 78 year old insulin-treated former smoker for evaluation of a toe infection and a numb foot. He proved to have mild organic brain disease, peripheral neuropathy and a paronychia. Doppler sounds were absent in the distal foot. He had pseudohypertension at the ankle with an ankle/arm index of 1.6. Medial calcinosis of the pedal vessels was seen on his foot X-rays.

The big toe was reddened and the medial side of the nail was ingrown and infected.

A portion of the nail was cut away and the infected tissue sterilized with a gentamicin injection before his Mini-Boot therapy on 3 consecutive days. His sensation improved within a few days and his skin pinked up over his ten day course of treatment.

He was brought back a few months later with an abscess of his fifth left finger. This also responded nicely to a few local injections of gentamicin.

He died two years later with a myocardial infarction.

Comments: Patients with organic brain disease cannot be trusted to take their medications, especially if their spouse is also disabled. Here local injections of gentamicin and an unknown amount of oral antibiotics cured the infections

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