Case 14: Both Legs Saved in Blind Diabetic Who Failed Hospital Therapies Elsewhere

Necrotic Heel Ulcers on Presentation

At age 67 this blind diabetic male presented in a wheelchair in the office with an ulceration over the left ankle that had been present over a year and with a right heel ulcer that had been present for several months. Bypass surgery and multiple debridements during an 80 day hospitalization in an urban academic center had not helped. He had been sent home to fare for himself except for the care of a visiting nurse who was to change his bandages. The visiting nurse referred him for boot therapy.

Boot treatment was begun as an outpatient with some success. His blindness, transportation difficulties and inability of the visiting nurse to continue her visits necessitated hospitalization. His daily treatment was initiated with cleansing soaks with multielectrolyte solution (Sea Soaks) and Betadine. He received Long-Boot treatments with wet-to-dry dressings (Sea Soaks with appropriate antibiotics.... vancomycin and gentamicin initially) over his ulcers. He also received a two-week course of intravenous ceftazidime. His pain was relieved and his legs reduced in size. He spend five weeks in the Bryn Mawr Hospital and was subsequently transferred to a nursing home for continued boot therapy. His legs healed nicely. Able to walk without difficulty, he returned home and subsequently has come into the office for an occasional booster therapy.

Ulcers Healed and Patient Ambulatory

Comments: The boot therapy reduced his leg swelling, functioned as a cardiac-assist device and provided enough of an improvement in the circulation of his legs to permit healing and rehabilitation. His previous physicians had not been able to do it.