At age 60 in December of 1987, this man was both a smoker and a type 1 diabetic. He was treated successfully for rest pain and half block claudication of both legs in 1987 and when he relapsed in 1992. In 1988, his leg veins were harvested for coronary artery bypass surgery. In 1991, he was also successfully "booted" for a calf ulcer. His insurance coverage and arteriosclerotic heart disease took him elsewhere. He returned May 22, 1994 with a plantar ulcer that penetrated to the bone, with cellulitis of the dorsum of his foot and a series of red areas up the anterior-medial aspect of his calf. The picture shows the plastic bandage his nurse had applied; it was effectively trapping the drainage of his bloody discharge. He was hospitalized for 13 days with sepsis, congestive heart failure and renal failure (highest BUN 127mg/dl).

He was initially treated in the hospital with intravenous antibiotics, the Long-Boot and the Mini-Boot and local antibiotics. Serial x-rays of the foot suggested his osteomyelitis, thought to be present on admission, had been aborted. His Long-Boot therapy was associated with an improvement in his cardiac and renal status. At the time of discharge his BUN was 23mg/dl. His therapy was continued in the office, first daily, then tapering to a few times a week until he was cured. The insulin syringes used for his last local antibiotic injections are seen on the stool. Having joined an HMO a few years later, he was hospitalized on October 23, 1997 for congestive heart failure and chronic renal failure. His legs were still intact. With his multiple problems, he was not thought to be a good candidate for dialysis. He died at age 70 with diagnoses of congestive arteriosclerotic cardiomyopathy, diabetes mellitus, chronic obstructive pulmonary disease, calcific aortic stenosis and insufficiency, mitral and tricuspid regurgitation and a recent myocardial infarction.