Case 117: Black lesions in Both Big Toes Respond Quickly to Mini-Boot

This man developed diabetes at age 9 in 1945 after a bout of chickenpox. In recent years he had occupational and domestic reverses perhaps promoting a loss of concern about his diabetes. He presented here with painless and unexplained lesions of the tip of his right first toe and on the top of the left first toe. His vascular testing showed a loss of amplitude and widening of the Doppler waveforms of several of his tibial vessels pointing to arteriosclerotic obstructive changes in those vessels. The blood pressure in the anterior tibial was 142 at the right ankle and 118 mm Hg at the left ankle. The pressure in the posterior tibial was 148 on the left and 146 on the right. Position sense was diminished in his toes.

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His skin lesions are apparent. He had lost hair on his feet and lower legs but his skin was well nourished.

Both feet were treated with the Mini-Boot over five days. His lesions appeared to be doing well and the treatment was stopped. By the tenth day, the superficial necrosis pealed off . He had no further problems over the several subsequent months after which he was lost to follow-up. He was advised that his lesions might represent emboli from proximal arteriosclerotic disease. He had not the interest or the wherewithal to pursue further studies. The etiology of his lesions remains uncertain.

Only a small scab remains here on the dorsum of the left 1st toe.

Comments: This was a simple case and a quick result. We would like to feel that many of our marathon cases could have been much quicker also if seen earlier.