Case 13: Ulcers, Necrobiosis Diabeticorum and TcPO2 Levels Benefited

Fiery Red, Well-Demarcated, and Bilateral Lesions on Presentation

This 68 year old man was an insulin-dependent diabetic and a former smoker. He was referred May 28th, 1993 for therapy of "necrobiosis diabeticorum", which was complicated by ulcerations over his right lateral malleolus and over his left internal malleolus. He had a history of myocardial infarction, a right femoral-popliteal bypass and a right transmetatarsal amputation . The stump of the amputation site was also breaking down. Baseline vascular testing revealed transcutaneous PO2 levels of zero in the ruborous areas and ankle/arm blood pressure indices of 0.57 and 0.71 in the right and left legs respectively. He had no fever, leukocytosis, discharge or sign of infection.

Both legs were treated in the Long-Boot and did well. His ulcers healed and his TcPO2 levels rose to 34mm Hg. He was discharged from the office November 8th, 1993. He returned August 4th, 1994 because of pain in the left leg which suggested that new ulcerations were likely. He again was treated in the Long-Boot and did well He was discharged from the office August 26th, 1994 and has not required therapy since..

Ulcers Healed and Rubor Fading, Nov '93

Pain-free and Rubor Almost Gone, Aug '94

He decided to transfer his overall diabetes care to our unit. He was introduced to home glucose monitoring and given our diabetes instruction materials. He became essentially euglycemic. His legs have not required additional boot treatment. Indeed, as shown in his final pictures, with the improvement in the control of his diabetes, the discoloration in his legs has totally faded.

The discoloration of his legs is gone. He requires occasional sanding of the callus on his stump. November 15th, 1996

Comments: Like case #12 , this man did have peripheral arteriosclerosis obliterans and localized plaques of ischemic tissue in the lower leg. Both responded nicely to boot therapy alone. What other therapy was possible for them? Could it have been done as effectively, safely and economically? The possibility of stasis disease, of course, is suggested by the location of his lesions. It might be expected that stasis changes would recur in an active person without treatment. Here the lesions were greatly ameliorated by pumping and disappeared over time with improvement in the control of his diabetes.